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June 16, 1999

American Medical HistoryAmerican Medicine and the Public Interest: A History of Specialization

Author Affiliations

Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999American Medical Association

JAMA. 1999;281(23):2251-2252. doi:10.1001/jama.281.23.2251-JBK0616-4-1

When Rosemary Stevens emigrated from the United Kingdom to the United States in the 1960s, she was perplexed by what she saw as the disorganization of US medicine, which seemed jarringly messy compared with the structured patterns of the British National Health Service. Already an accomplished student of health care delivery systems, as exemplified in her important book Medical Practice in Modern England: The Impact of Specialisation and State Medicine (1966), her comparative perspective both complicated and greatly enriched her subsequent exploration, American Medicine and the Public Interest, first published in 1971. Writing at a time when the lament that American medicine was in crisis had grown commonplace, she argued compellingly that specialism had been the most powerful organizing principle for the American medical profession in the 20th century, and a comparativist sensibility helped her to recognize how in the American context arguments about change and choice were so persistently couched in terms of shifting and often conflicting definitions of the "public interest."