The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry

The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry

Paul Starr

Language: English

Pages: 528

ISBN: 0465079350

Format: PDF / Kindle (mobi) / ePub


Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries.

"The definitive social history of the medical profession in America....A monumental achievement."—H. Jack Geiger, M.D., New York Times Book Review

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college admitted only 168 fellows; it included about the same number of licentiates, its lower rank. No doctor could gain admission to the college as a fellow unless he had graduated from Oxford or Cambridge, even though neither university provided a medical education. At Oxbridge physicians studied the classics; at the London hospitals they acquired more practical experience. This system, poorly adapted for advancing science, was well adapted for advancing careers, for professional success

you are, after all, but an ordinary person."24 Manuals of personal advice generally come in two varieties: vague, uplifting, moralistic treatises filled with tedious pieties; and nononsense, amoral guidebooks to getting on in the world. Cathell's manual fell into the second category, and consisted fundamentally of rules for what Erving Goffman has called "impression management." In the interests of presenting an idealized image of the physician, it attached paramount importance to his manner and

reformation."87 The deficiencies had remained the same for decades. Students came to professional schools with minimal preparation; even at the best universities, young men without high school diplomas could easily find admission to study medicine. Students followed medical courses in any order they pleased; the brief two-year program had no regular sequence. In Germany the laboratory sciences of physi- 114 A Sovereign Profession ology, chemistry, histology, pathological anatomy, and,

convinced; a few voices even urged movement in the opposite direction. A number of critics had long maintained that American hospitals were, if anything, too loose for the good of their patients and their own budgets. European hospitals, conducted by a small, permanent medical staff, stood as an example of more disciplined and economical organization. In American hospitals, observed Arpad Gerster, with a rotating staff of visiting physicians and changes every year in the house staff and student

worried that efforts might be made to convert some of their members in moments of personal crisis. Enter- 174 ^ Sovereign Profession ing a hospital necessarily involved encounters with strangers at times of weakness and vulnerability, but the encounters might be less threatening if the hospital authorities and staff were of the same faith or, even better, of the same ethnic background. For even within religious groups, there were sharp differences, as a Russian Jew in New York in 1894 found

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