Wednesday, June 11, 2008

Medical manpower in Oregon

In November of 1972, the Oregon Medical Association released a Physician's Study: Oregon, 1950-1972. Compiled by Harold T. Osterud, Hugh Tilson, Keith Griffin, and Robert Dernedde, the document is the "preliminary report" of the "Office of Practice Survey of physician manpower," which was created circa 1970 to research the state's need for "personal preventive medical services."

The report begins by challenging some of the very assumptions that undergirded the creation of the Office:
Premise I: It is highly artificial to attempt to separate preventive medicine from curative medicine.
(Old saws about ounces and pounds notwithstanding.)
Premise II: The medical profession cannot guarantee optimal health for man.
(The true death knell for the "golden age" of medicine? Physicians removing themselves from the pedestal and rejecting apotheosis!)
Premise III: The prime prerequisite for preventive medical services is the availability of physicians to a community.
(Although this report was written in the pre-Internet age, I suspect this assertion is still valid. Sure, you can read about good nutrition online, check your fitness levels on gym machines, and monitor your own heart rate on those contraptions they have in the pharmacy areas of large grocery stores, but it's hard to get a virtual flu shot.)
Premise IV: The distinction between private and public medicine is not useful in achieving improved medicine in Oregon.
(We're all in this together, people.)

Premise V has no short, snappy title. It is a summary of doubts and uncertainties that question the very idea of the survey, including such truisms as "where there are physicians, it is by no means clear that they all practice good preventive medicine."

A report that lays its own shortcomings bare in such a fashion can only recommend itself as a fantastic, authoritative, and important document. Would that all reports were as introspective!

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