Dr. David E. Hogan, Vice President of Educational Development and Chair Emerging Infectious Disease Taskforce
Introduction
In Part One of this article, Dr. David Hogan explored how a bold decision to vaccinate Continental soldiers at Valley Forge helped preserve an army and perhaps a nation. In Part Two, he examines four enduring principles that have shaped the evolution of American medicine and continue to influence healthcare today.
Part Two: Four Principles That Shaped Healthcare
When we think of American medical advancements over the last 250 years, we could certainly list technical milestones. However, it is not technical milestones, but the attitudes of leaders in American medicine that have taken us from a from a largely apprenticeship-based profession to the outcomes-based clinician/scientist of today. In general, these attitudes revolve around four basic tenets.
1. Reason Over Rote
A number of theoretical medical foundations existed in America 250 years ago. These were based on the intuition and rote methods of the practitioner, without scientific validation. Balancing bodily “Humors” was popular which as example, likely hastened the demise of George Washington through bloodletting. So-called “Heroic” medical theory saw the use of blistering, purging, dunking in freezing water, and mercury poisoning as cures to various maladies based on the opinions of charismatic practitioners. Consistent application of the scientific method starting at Johns Hopkins in 1889 set American medicine on the path towards today’s science-based outcomes. This spread to other institutions infusing medical education and practice with a foundation based on reason, not rote.
2. Find The Best And Bring It Home
Medical leaders in America often sought the best training and methods throughout the world. These methods would then be brought home, improved upon, and made part of American medical education and practice. This is perhaps best exemplified by the diaspora of over 700 Americans to the established schools in Paris, France from 1820-1860. Much was also learned from the English, Scottish, Irish, and German systems. On their return, most applied their new knowledge to the American system by establishing well-organized medical schools and teaching hospitals. The attitude was to find and adopt best practices and bring those practices home.
3. Teaching How To Think, Not What To Think
Throughout most of the 1800s, becoming a doctor meant following a doctor around for a few months, before going into practice with no formal education. Some obtained a medical diploma through one of the many unregulated, for-profit medical schools. In 1910, The Flexner Report researched the nature of American medicine. It found only four of the 155 American medical schools based their curriculum on science. Standardization of medical education including college pre-medical, two years of academic/laboratory, and two years of clinical training was finally adopted. This gave the aspiring doctor the training and tools to “think critically” and ask questions rather than do whatever they were taught without thinking.
4. Share Best Practices
American medicine has gone from routinely seeking the best practices elsewhere, to being the source of many best practices. Just as Americans absorbed from the Europeans, much of the world now comes to America to learn. An American attitude of openness fosters this. This open attitude has improved not only the health and well-being of Americans, but of people throughout the world.
These American attitudes – not without controversy and always with initial opposition – are what have advanced American medicine from an apprenticeship-based profession to a respected scientific profession. Scientific advancements such as germ theory, public health, antisepsis, antibiotics, anesthesia, medical imaging, surgical advancements, and others are the foundation of medical improvements in the human condition. However, it is those Americans who were willing to accept these advancements through promotion of science over intuition, adopting and sharing of best practices, and questioning authority when they needed to be that have made the difference. As we reflect on 250 years of American medicine, let’s not lose sight of what brought us here or what will carry us forward.
Closing
As the United States prepares to commemorate its 250th anniversary, the story of American medicine reminds us that progress is not driven by discoveries alone, but by the willingness to question assumptions, pursue knowledge, embrace innovation, and share what is learned for the benefit of others.
Those same principles remain relevant today. At TeamHealth, clinicians across the country carry forward this legacy every day by applying evidence-based medicine, collaborating across disciplines, and continually seeking new ways to improve patient care. As we look ahead to the next chapter in healthcare, the lessons of the past offer both perspective and inspiration as we continue advancing patient care for generations to come.
Read Part One of this article here.
