Talk:History of Medicine (United States)

So far, the history of American medicine is extremely short!  :-) --Larry Sanger 20:10, 6 March 2007 (CST)

Holy Moly, no doubt! :)-Matt Innis (Talk) 21:10, 6 March 2007 (CST)

References

Oliver, Thomas R. Policy Entrepreneurship in the Social Transformation of American Medicine: The Rise of Managed Care and Managed Competition [View in PDF] Journal of Health Politics, Policy and Law - Volume 29, Number 4-5, August-October 2004, pp. 701-733

Starr, Paul - Social transformation of American medicine.

I had just welcomed the a co-author, before I noticed that mostly he has erased everything I've written. I could put it back and go on, I guess, but its a dull task and a thankless one. Nancy Sculerati MD 13:13, 8 March 2007 (CST)

I did move sentences around but I only cut a couple. (on genetic isolation and on public health in ports that was unclear what century was being discussed.). Richard Jensen 13:26, 8 March 2007 (CST)

Richard and others, this article is about Medicine, the history of the Medical profession in the United States and, medical education - as pointed out in the original introduction. The business about the diseases in the New World being few and far between as compared to the old world was mentioned because it lead to a great financial support of public quarrentine facilities in NYC, that laid the foundation for public hospitals. These, especially after the Flexner report in 1910, led to a system of medical education that combined University training with post-graduate residency training, on a model of John Hopkins, that incorporated some of the great public hospitals of the United States with the finest of the University Medical Schools. This article can also expand on some of the topics brought up in Chiropractic. Although I am very open to others input, and am particularly delighted at a historian's interest, the" Public Health" or" History of Epidemic and Infectious Diseases" or "Medical history of the population of the United States" is really an entirely different article. I'm not coming up with a great title, but I encourage you to do so, Richard. We can move the disease and life span, neonatal mortality etc stuff there. Here, this article should fit in with a larger History of Medicine article, and this one should concentrate on the fascinating history of the medical profession in US. Nancy Sculerati MD 17:06, 8 March 2007 (CST)

Nancy, you might like to take a look at this [1] as a resource. It's a wonderful museum, and I have "Medicine Man", the book of the museum. Wellcome was American born but worked in the UK, but travelled widely and collected avidly; the Wellcome Foundation accordingly remains a strong supporter in the UK of research into the history of medicine. Minor point; should it be United States or USA? I think the latter is generally used outside the US which is why I tend to change it.

Gareth Leng 04:05, 9 March 2007 (CST)

I suggest that the history of medicine has to include the question of what disease environment doctors encountered, and how much difference their practice made. Hence mortality data seems highly relevant. Richard Jensen 05:56, 9 March 2007 (CST)

"the requirements for obtaining a medical degree"... suggest replacing with qualifications needed to practise medicine (or something similar) - an MD in the UK for instance is a higher degree, not simply the qualification to practise, and is accordingly (I think) higher degree than the American MD - I may be wrong..... Obviouly qualifications to practise differ in different countries and qualifictions are not generally mutually recognised.Gareth Leng 06:28, 9 March 2007 (CST)

I think you are wrong Gareth- and I think that this article should emphasize the "American". You see, medicine was regualted in England after this 1858 (?plus minus a couple of years) Medical Act, and in France from the start of the 19th Century. In the USA, unlike Europe, there were little to no restrictions on what a medical school had to teach or what qualifications a "doctor" had to have. After the Flexner Report (1910), there was a big reform and the routine qualifications of all MDs became, at least on paper, higher than the european minimum. Whereas before those Flexner reforms, some medical schools required nothing more than tuition, and others demanded some college study-knowledge of Latin etc as a prerequisite, afterwards the US system of medical schools became a post-baccaleaurate program. By and large, for most of the 20th Century -4 years of university study-with a degree earned at the end, were required for entrance to medical school. first year medical students are age 22 in the US-and up. Medical schools became 4 year programs, and by the 50s-60s, formal clinical training for at least a year after medical school was standard before a license was granted. By the 70's -80's, board certification in a specialty was becoming common, and residency training programs ranged from about 3 to 7 years after the MD was granted. So, the systems are not the same. There are other differences too, in terms of how much responsibility residents have -it's more here. That's because the residency training rograms in the USA were modelled on Johns Hopkins- Abraham's Flexner's "gold standard". So again- here in the US the MD is ahigher degree, and is NOT enough to practice with, you need at least a year of residency after that and must pass many tests. Nancy Sculerati MD 06:48, 9 March 2007 (CST)

You're right Richard, about the diseases, and mortality- and, the word Medicine also includes the knowledge and practices, the art and science of Medicine - and so those need to be explicitly included, too. So we might just all continue, and as the article will surely grow out of bounds, we can keep sections on all these topics in- and produce whole additional articles besides. Nancy Sculerati MD 08:29, 9 March 2007 (CST)

Sorry Nancy, I didn't make myself clear. I agree that the qualifications to practise are higher in the US, but the MD degree in the UK is a much higher degree than the qualification to practise, so I'm not sure where the degree stands in relation to the American MD. My comment was about the wording used - i.e. exactly was meant by "a medical degree".Gareth Leng 10:58, 9 March 2007 (CST)

I don't know- what is required for a medical degree in the UK? Since this article is about the United States, a medical degree here means the MD degree received on graduation from medical school, and- although it does not require a thesis, it is roughly equivalent to a Ph D, another kind of doctorate. If you were to get a Ph D in science in the US-for the most part- you would have to graduate from college with a suitable amount of math and science, then earn a couple of years worth of graduate school credits in science. That part is pretty much the same for both MDs and Ph Ds here. However, where as the Ph D student then becomes a "lab rat" :-), the MD then becomes a house officer- both of them generally putting in very long hours working on a practical application of the knowledge base, while learning lots more. My general understanding of the European system is that the medical track starts in college rather than afterwards. Nancy Sculerati MD 11:20, 9 March 2007 (CST)

Problems of incommensurability.... In the UK a typical undergraduate degree in science takes 3 years from 18 to 21; in Scotland it's 4 years because in principle we can take students with 1 year less of pre-University education, so we have a foundation year. What is known here as a "Medical degree" is the MBChB, this takes five years from 18, and another year (the registration year) in supervised practice is required for licensing. The MD is a postgraduate degree (for those already qualified to practise in medicine), and is generally a clinical research based degree undertaken part time by relatively senior hospital based doctors. So the MD here is a (clinical) research degree. Not better, higher etc but just different. I raised the point not to make any case for the relative quality of training, only to alert you to the ambiguity of the wording - in other words, what exactly is understood by a medical degree, and for this reason I thought that "qualifications required to practise" might be a better wording.Gareth Leng 06:20, 10 March 2007 (CST)

I think that the article on Medicine in the USA should stick to terms used and understood in the USA. Hopefully, making the system so clear that a person from outside the USA can understand it. Here, no degree is given after internship and the MD does not qualify its recipient to practice. Hopefully. also, there will be articles on Medicine in other countries so that the differences will be distinct. Again, there is no degree in the USA that qualifies for the practice of Medicine. It is strictly an academic degree and so I can't use your suggestion. (It confuses even me :-) ! But we can make sure that the terms medicasl degree and MD are fully explained. Nancy Nancy Sculerati MD 09:01, 10 March 2007 (CST)

Sorry Nancy, theres just crossed wires here, I'm not trying to say what I think you think I am. The problem sentence is "the requirements for obtaining a medical degree became more, rather than less, stringent than in most other western countries." and the problem is that this needs an understanding of medical degrees outside the US - and ambiguity arises because its not clear to me exactly what degrees you're comparing(and if youre comparing MD with MDit wouldnt be appropriate). If instead you said "the qualifications needed to practise medicine became more, rather than less, stringent than in most other western countries." that would be clearer for me Gareth Leng 12:45, 10 March 2007 (CST)