A financial officer at The Johns Hopkins Hospital recently said to me, "Medicine is a simplistic name for an evolving creature that no more resembles what it was 20 years ago than the US resembles the original 13 colonies." Paul Starr1 may have put it more eloquently, but my friend is right. There is and has been a quiet revolution going on in American medicine.2 In 1957, when I entered medical school, many hospitals were segregated by race and class as well as sex. At one teaching hospital at which I trained, ambulance drivers were asked to wait intil patients were preliminary assessed to be ready to transport them to a municipal hospital, if they were not considered instructive admissions. At another, patients clearly needing hospitalization balked at being admitted because they lacked financial coverage. The length of stay for myocardial infarction had been halved in that decade
See also p 3418.
Dans PE. The Health Care Revolution: A Preliminary Report From the Front. JAMA. 1988;259(23):3452–3453. doi:10.1001/jama.1988.03720230062032