The Rise of Scientific Medicine and Professionalism
Although medicine had been previously viewed more as an art than as a science. several significant discoveries during the nineteenth century in areas such as back teriology and anesthesiolog y began to give medicineincreasing credibility as a science (Nuland, )997). At the same time that these discoveries were occurring, the ideology of science was being adl’o~ated in all areas of life. and people came to believe that almost any task could be done better if the appropriate scientific methods were used. To make medicine in the United States mo e scientific (and more profitable). the Carncgic Foundation (at the request of the American Medical Association and the forerunner of the Association of American Medical Colleges) commissioned an official study of medical education. TIle “Flexner report” that resulted from this study has been described as the catalyst of modern medical education but has also been criticized for its lack of objectivity The Flexner Report To conduct his study. Abraham Flexner met with the leading faculty at the Johns Hopkins University School of Medicine to develop a model of how medical education should take place; he next visited each of the 155 medical schools then in existence. comparing them with the model. Included in the model was the belief that a medical school should be a full-time. research-oriented, laboratory facility that devoted all of its energies to teaching and research. not to the practice oi medicine (Kendall. 1980). It should employ “laboratory men- to train students in the “science” of medicine. and the students should then apply the principles they had learned in the sciences to the Illnesses of patients (Brown. 1979). Only a few of the schools Flexner visited were deemed to be equipped to teach scientific medicine; nonetheless. his model became the standard (or the profession (Duffy. 1976).
As a result of the Flcxner report (910). all but two of the African American medical schools then in existence were closed. and only one of the .medical schools for women survived. As a result. white women and people of color were largely xcluded (rom medical education for the first half of the twentieth century. Until the civil rights movement and the women’s movement . of the 1960, and 19705. virtually all physicians were white. male. and upper or upper-middle class. The Professionalization of Medicine adverse effect on people of color and women who
might desire a career in medicine. the Flexner report did help professionalize medicine. When we compare post-Flexner medicine with the characteristics of professions (see Chapter 13). we rind that it meets those characteristics:
1. specialized knowledge. Physicians undergo a rigorous education that results in a theoretical understanding of health. illness. and medicine. This education provides them with the credentials. skills. and training associated with being a professional.
2. . Physicians arc autonomous and (except as discussed subsequently in this chapter) rely on their own judgment in selecting the appropriate technique for dealing with a problem. ‘Yexpect patients to respect that autonomy.
3. Seij-regulation. Theoretically, physicians are self regulating. They have licensing. accreditation. and regulatory boards and associations that set professional standards and require members to adhere to a code oi eth cs as a form of public accountability.