MEDICAL MYSTERY: The Training of Doctors in the United States by

MEDICAL MYSTERY: The Training of Doctors in the United States

By
Email this review

KIRKUS REVIEW

An earnest, informed appraisal of medicine in the United States which criticizes the current policy favoring treatment over preventive services. Using a historical approach, Dr. Jonas demonstrates how the AMA emerged from the 19th-century clutch of medical associations as an increasingly powerful force; how the Council on Medical Education attempted to evaluate turn-of-the-century programs--an odd lot of unstandardized curricula; and how the Flexner Report, which did reorganize medical school structures, has been distorted in very basic ways. Many of educator Flexner's recommendations were acted upon and still stand--the requirement for pre-med courses or the use of lab and clinic observation in addition to classwork. But the report focused on prevention and the social role of medicine--long-ignored emphases which Jonas would reintroduce. He explores the inadequacies of fee-for-service private practice, research without accountability, overspecialization--the results of what he terms Disease-Oriented Physician Education (or, undiplomatically, DOPE). He also comes down hard on other controversial aspects: technological treatments which violate the ""first do no harm"" precept; codes of silence and other obstacles to quality control; an environment which fosters cynicism and stresses knowledge acquisition over performing ability. Although cogent as an analyst of deficiencies, Jonas is less perceptive as a reformer. His outline for Health-Oriented Physician Education (HOPE) needs refining but it does offer the basis for a productive discussion; certainly in its orientation it reflects what patients prefer. Written by an authoritative insider, this acutely discerning book deserves more than a ten-minute office visit.

Pub Date: Jan. 22nd, 1978
Publisher: Norton