After reading lengthy dissertations on aging, I am convinced that we either don't know much about aging at all or we refuse to accept what we are seeing. The refusal to accept our observations sounds more likely. This is a common theme in medicine.
I have been studying various outcomes studies and did a journal club on the pap smear, the major effective cancer screening test. I ran across David Lieu's excellent review of the pap smear in JFP in 4/96. The history of Papanicolaou was most interesting. Despite convincing research presented as early as 1928, skeptics prevailed. Only after 1942 and Dr. Papanicolaou's own monograph was published was the pap smear and modern cytopathology ushered in.
I can reflect back to Semmelweis and many others to remember similar failures on the part of medicine to accept changes that could save lives and prevent disease. Medicine is not alone. Seems like leaders in US industry failed to accept the move toward quality improvement and they and the nation suffered because of it. Many credit Demming and Juran for the modern quality efforts and the industrial model, but it is interesting that these "heroes" credit the Japanese managers, the "little people", who implemented the changes.
We physicians take far too much credit for our efforts and we now suffer most from the tremendous expectations of the public. This has forced a reckoning with the cost of care with family medicine and primary care at the heart of the effort. Again we have a crisis as witnessed by all of us in recent columns on fp bashing which is only our defensive physician way of looking at health care.
It is clear we must define quality and efficiency in health care, but we resist. We are on the brink of a new era of outcomes and quality, but still we cling to the professional model of health care delivery and resist the industrial. Isn't medicine a mysterious art more that an known science?
Quality boils down to technology and interpersonal factors, but it seems we would rather keep the interpersonal quiet and cover it up by the technology.
Will we adapt to change or come up with a new model for health care?
As proponents of the doctor-patient relationship and as established change agents in medical education, family medicine is certainly in a position to be of great assistance to medicine. It is clear that clinging to the professional model will only hurt us and our patients. Every new century has brought major changes in medical education driven by forces both in and outside of medicine. Flexner gets credit for recent changes much as Deming did recently, but the changes were underway by the "little people" long before his report facilitated efforts.
Family medicine is in a unique position to influence change in medicine and medical education. Will we consolidate our recent short term gains, or will we continue to adapt ourselves and medicine to be of service in the future?
It's in our hands.