MEDICAL MYSTERY: The Training of Doctors in the United States

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.