Flashback in Medical Economics

Article excerpt

25 years ago;

August 18, 1975

Over the years there'd been a growing clamor for medical schools to reorder their priorities in screening applicants. Personality and potential for relating compassionately with patients should be given at least as much weight as a candidate's intellect, the advocates for change had insisted.

Their insistence had paid off-too heavily, Contributing Editor Michael J. Halberstam maintained in his essay, "How Smart Does a Doctor Have to Be?" The pendulum had swung so far, Halberstam warned, that med schools were in danger of passing over the smartest applicants in favor of those with the most evident "human" instincts.

The Washington, DC, internist (whose brother, David, is a noted journalist and author) examined "fallacies" that he felt were taking hold among admissions officers, professors, and consumerists. One such fallacy was that the "art" of medicine is unteachable. "Nonsense," wrote Halberstam. "The reason the art of medicine is rarely learned is that it's rarely taught."

How should it be taught to med students, including those who have the intellectual capacity to learn it even if their compassion quotient seems low? "Putting excellent practicing physicians among medical students and allowing them to make rounds together isn't enough,"he argued. "Student and house officers' interactions with patients should be taped and restudied with the same care a football coach gives his game films."

Another fallacy-that compassion and intellect are mutually exclusive-also drew Halberstam's fire. "Motor skills among bright children are consistently better than those among average children," he noted. "In the same way raw intellectual ability and the ability to practice the art of medicine-that is, to see patients as fellow humans rather than as cases-are complementary."

Stressing the importance of intellect in doctors-to-be, Halberstam wrote: "Medicine is not a field for the average intelligence. The discrete bits of the art of medicine that we can identifyknowledge of, and interest in, the world around; ability to listen with the third ear; ability to communicate one's beliefs effectively to bureaucrat and parking lot attendant alike-these presuppose a high degree of intelligence."

Halberstam offered this suggestion to med school admissions officers: "Ignore applicants' expressions of a desire to 'serve humanity; or high scores for compassion' on psychologic tests. Look at who the candidates are and what they've done. I still think personal interviews are essential for this-you can find out more about an applicant's social skills and potentials in a half-hour's talk than from two hours of psychometric testing."

Savvy advice from a doctor whose intellectual abilities rivaled just about anyone's. But sadly the medical profession had little time left to benefit from that intellect. A few years after this essay was published, Mike Halberstam was killed by an intruder in his home.

50 years ago:

August,1950

Only a few pages apart in our August issue, passionate arguments were mounted for and against a federal health insurance program. The "for" spokesman, predictably was an official of organized labor. Just as predictably, the voices of opposition came from the leaders of the American Medical Association.

"The demand for health insurance should be met by a comprehensive health program developed within the framework of our national Social Security policy" said Harry Becker, director of the UAW-CIO's Social Security department. "Such a program would further medical research, preventive medicine, the training of professional personnel, the establishment of hospital facilities, and the financing of medical care needed by all members of society."

Becker slammed the AMA for championing private insurance as part of an aggressive campaign to block a government health plan. "The insurance companies at best give only cash benefits," Becker noted, "and these bear no direct relation to the cost of the worker's medical care" He aimed an arrow at practicing physicians, as well. …