Old and Sick in America: The Journey through the Health Care System

By Muriel R. Gillick | Go to book overview

CHAPTER EIGHT
The Transformation of the American Hospital,
1965–2015

Memory is a tricky business. Our natural tendency, or at least mine, is to take the current reality for granted, to assume things have always been the way they are now. Even though at the time I began my training as a physician, the personal computer did not exist and doctors and nurses sat at long tables and wrote up their progress notes, when I conjure up an image of a hospital today, I imagine dozens of computers, each with a physician or nurse seated or standing in front of it, busily entering or retrieving data. Even though when I was an intern, lab test results were either telephoned to the ward secretary or written on small slips of paper, I literally cannot remember what those slips looked like now that I’ve seen nothing but computer printouts and screen displays for years.

To understand how the hospital of the early 1960s, the immediate preMedicare era, has been transformed over the last fifty years, we need to begin by going back in time and looking at what hospitals were actually like then. But because doctors and patients at the time presumably also took their institutions for granted and assumed they were more or less the same as they had always been, and probably exactly the way they had to be, they didn’t leave much in the way of a detailed record. To be sure, there were gripes, some features of hospitals that people could conceive of improving, and those gripes were sometimes published in medical journals or as op-eds. And we have a statistical record of hospitals: the United States government has for decades collected reams of extraordinarily valuable data about all sorts of aspects of American life. We know, for example, how many hospitals existed in 1965 and what sorts of medical problems brought patients into the hospital. We know what the average length of stay was at an American hospital in the year before Medicare went into effect. But, for a description of how a hospital looked from the perspective of what people at the time regarded as important, we have to turn to a journalist’s account of the opening of a new hospital. Quite fortuitously, a new hospital opened its doors in New York City in January 1966.

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Old and Sick in America: The Journey through the Health Care System
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Prelude ix
  • Abbreviations in the Text xxi
  • Part I - The Office 1
  • Chapter One - Going to the Doctor 3
  • Chapter Two - The Lay of the Land 23
  • Chapter Three - From the outside in 41
  • Chapter Four - The March of Time, 1965–2015 61
  • Part II - The Hospital 79
  • Chapter Five - Entering the Palace of Technology 81
  • Chapter Six - The Varieties of Hospital Experience 97
  • Chapter Seven - The Hospital through Other Eyes 113
  • Chapter Eight - The Transformation of the American Hospital, 1965–2015 133
  • Part III - The Skilled Nursing Facility 151
  • Chapter Nine - Going to Rehab 153
  • Chapter Ten - Different Snfs, Different Miffs 169
  • Chapter Eleven - Movers and Shapers 184
  • Chapter Twelve - Now and Then 202
  • Finale 223
  • Acknowledgments 245
  • Notes 247
  • Bibliography 267
  • Index 293
  • Studies in Social Medicine 301
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