Medical Education and the Community

MEDICAL EDUCATION AND THE COMMUNITY* WILLIAM H. STEWART, Af.D.f I am honored and pleased to have been nominated for the Kober Lectureship in this first year of my tenure as Surgeon General of the Public Health Service. Dr. George M. Kober, who established this lectureship in 1923 on the fiftieth anniversary of his graduation from this medical school, was evidently a man whose vision spanned the entire health world. His commitment to scientific medicine marked him as being well ahead of his time; in fact I am informed that the immediate object ofthe first lecture was to present scientific data to support research at a time of vigorous antivivisectionist activity in congressional hearings—a subject as timely as tomorrow's newspaper. At the same time he had an abiding interest in preventive medicine as well as in medical care itself. More than four decades have passed since the first Kober Lecture was presented here. They have been the most turbulent decades in human history. In the world of medicine these four decades have witnessed a greater accumulation ofknowledge than in any previous four centuries— perhaps than in all the previous annals ofmedicine. Yet the basic elements of the medical equation remain essentially the same. Our thirst for new knowledge is as great as ever, and our investment in acquiring that knowledge through research has multiplied manyfold. Our need to apply the benefits of new knowledge through preventive medicine and medical care becomes more urgent with every passing year. And the medical school remains the pivotal institution—both in generating new knowledge and in shaping the course of our medical future by the training it gives to oncoming generations ofphysicians. * Delivered at the George M. Kober Memorial Lecture at Georgetown University School of Medicine, April, 1966. Reprinted with the permission ofthe Medical Annals ofthe District oJColumbia and the Georgetown Medical Bulletin. t Surgeon General, Public Health Service, U.S. Department ofHealth, Education, and Welfare. 462 William H. Stewart · Medical Education Perspectives in Biology and Medicine · Spring 1967 What kind ofmedical future are we shaping? Are we preparing the new generations ofphysicians to serve the health needs ofthe next decade and the next century? There is a lot oftalk these days about the crisis in American medicine. Granting that the word crisis has been badly stretched out of shape by overuse, I think we are at a point of crisis in something like its original medical sense ofa turning point. I believe we have reached a crisis ofunfulfilled expectation on the part ofthe people we serve. The American people have accepted the principle that the best in health care should be theirs by birthright. In part we have brought this acceptance upon ourselves by proclaiming the wonders ofscientific medicine. In part it has evolved out ofgreat economic and social changes in the society as a whole. In any event, the people have set a new goal for us: the best in medical care, not for some ofthe people some ofthe time, but for all ofthe people all of the time. The great legislative programs in health of the past few years are an expression, by the President and the Congress, ofthis aspiration . Now it is up to us to raise our sights so as to hit the new target. And I believe that the medical education establishment which most ofyou represent , as both students and teachers, is the institution in our society that must take the lead. That is why I have titled this lecture "Medical Education and the Community." Let's take a closer look at this present crisis of ours. And in doing so let's try to step outside our professional personality and look at medicine through the eyes of the people we serve—the people whose aspirations will be the true measure of our success. As a profession we tend to talk a great deal about the physician-patient relationship, frequently vowing to defend it to the death. But we give very little thought to the patient-physician relationship, viewed from the other side. Occasionally a brave patient speaks out. Alistair Cooke recently observed that thepatient-physician relationship is one ofconstant humiliation for the patient. When...