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June 3, 1988

American Medicine's Problems, Opportunities, and Enemies

JAMA. 1988;259(21):3174. doi:10.1001/jama.1988.03720210064032

In a recent issue of THE JOURNAL, I wrote, "In developed countries, the Golden Age of Medicine is at hand—for the patients."1 While it is evident that our resources and our accomplishments are truly extraordinary, we are far away from having achieved any kind of medical utopia. This editorial attempts to identify some of the myriad reasons hindering realization of that distant ideal and suggests proper responses.

See also p 3171.

There are three basic ways to manage any enterprise. One is by strategic planning, setting goals and objectives, identifying the resources needed to address them, and then proceeding with iteration and accountability. Another approach is to identify and analyze problems as they arise, set priorities, and logically set about solving the problems. A third and less desirable (albeit commonplace) way is simply to muddle through, defending the status quo against change until change becomes mandatory.

Applying a strategic