This is a meaty book, dense with facts and details, marvelously referenced, meant for both physicians and patients.
Journal of the American Medical Association
This is a clear, fascinating, exhaustive, and telling book describing the development of medical education in the 20th century. The author, one of the leading historians of medicine in the world and practicing physician at Washington University Medical Center in St. Louis, has divided the century into thirds for heuristic purposes, but there are really two objectives: first, to discuss the heroic build-up of the system of teaching physicians in the first portion of the century and second, to alert readers to the changes in medical education affected by the massive rise in research and practice, including recent restrictions imposed by managed care. His thesis is that the emphases on research and earning money from practice have nearly crowded teaching out of the academic medical centers and their medical schools, and that some sort of denouement is occurring with restrictions now being imposed by governmental and private funding sources. The thesis put forth by the author is likely to be received well by the intended audience -- those working in academic medical centers, other interested physicians, insurance companies, policy makers in and out of government, and interested laymen. The author appears to have visited a huge variety of medical institutions and their archives, and to have read nearly everything pertinent to his subject and digested it. This is reflected in the narrative, tabulations, anecdotes, and the nearly 100 pages of closely packed references and commentaries in the notes at the end of the book (well worth reading by themselves). This is an attractive, well-referenced, and authoritative book. There is no other historian of medicine so well situated to write thisbook, which will become the definitive work on the subject.
This important critique of U.S. medical education from WWI to the present makes painfully clear that the training of the nation's doctors could be vital to your health. Ludmerer, professor of medicine and history at Washington University, argues that the primary commitment of medical schools and teaching universities to education has been severely compromised. The main culprit, in his diagnosis, is managed care, especially HMOs, with their emphasis on cost cutting through limited use of medical services and the substitution of nurse practitioners for M.D.s whenever possible. Today's ultracompetitive corporate environment, asserts Ludmerer, has left medical schools reeling, with a sharp decline in teaching standards due to a fundamental shift toward increasing the volume of patients, doing research that will bring in federal funding and aggressive expanding of private practice by faculty members. Things were not always this way, he insists, in this sequel to Learning to Heal (1985). From the 1920s to the '40s, American academic health centers were, by his reckoning, congenial places marked by a disdain for commercialism and a willingness by clinicians and pathologists to expose errors--though he admits such shortcomings as the old round-the-clock work ethic and the barriers to minorities and women seeking advancement in medicine. While this dense scholarly study offers few prescriptions, it should be read by anyone concerned about the vitality of the U.S. health care system. (Oct.) Copyright 1999 Cahners Business Information.
Publishers Weekly - Publisher's Weekly
Ludmerer (Learning To Heal; medicine, Washington Univ.) reviews American medical education from World War I to the present, examining its exponential growth and response to social trends. While some of this thoroughly researched and well-documented work may be of interest only to academics, most of it concerns us all: Ludmerer looks at the future of medicine in America and reveals some very disturbing trends in managed care, education, and research funding. With a wealth of factual details and insightful questions, this book is destined to have an impact on the future of medical education. Highly recommended for all libraries.--Eric D. Albright, Duke Medical Ctr. Lib., Durham, NC Copyright 1999 Cahners Business Information.
Drawing on medical institution records he was often the first to review, this medical educator and historian at Washington U., St. Louis, chronicles the evolution of US medical education through periods fulfilling and breaking the social contract: from the early 1900s emergence of modern teaching hospitals, to the current managed care system and his prescription for reform. Includes 90- plus pages of chapter notes. Annotation c. Book News, Inc., Portland, OR (booknews.com)
Kenneth Ludmerer, M.D., gives us a much-needed perspective on medical education in America....Over eleven years in preparation, the work is scholarly and meticulous with over 600 sources. It is written with integrity and insight and the reviewer often paused to admire and savor the parsimony and elegant turns of phrase. Bulletin of the Medical Library Association
[An] important new book. It has stirred up the academic medical community, as it should; but it deserves a wide public readership as well. No consideration of the future of health care in the United States can afford to overlook the historical facts laid out by Ludmerer.New Republic
Featured as an 'Essential Purchase ' on Doody's Core Titles List for 2018
"We must not let the future [of medicine] happen, we must make it happen. Ludmerer's extraordinary book provides the foundation—and inspiration—for doing this."—Jerome Kassirer, New England Journal of Medicine
"Its writing is sufficiently riveting and its message important enough to capture any reader.... Before you or your loved one checks into an American teaching hospital for critical care, read this book."—Newsday
"Persuasively written and meticulously researched, providing an exceptional foundation for understanding the problems American health care and medical education face in the next century."—St. Louis Post-Dispatch
"No consideration of the future of health care in the United States can afford to overlook the historical facts laid out by Ludmerer."—The New Republic
"This important critique of U.S. medical education from WWI to the present makes painfully clear that the training of the nation's doctors could be vital to your health."—Publishers Weekly
"A superb book, perhaps the most significant work of American medical history to have been published in the last quarter-century."—Choice
"A magisterial book, bound to attract more than the scholarly attention...this book will make Ludmerer the most eminent historian of American medicine of his time and a notable figure in the medical profession into the bargain."—Donald Fleming, History Department, Harvard University
"This brilliant historical account...is more than a work of breathtaking scholarship. It is also a work of great social and moral stature...The message of the book is not that medical education and the health care system are beyond redemption. Quite the contrary, it is a challenge for their redemption."—Renee C. Fox, Social Sciences, University of Pennsylvania
"Ludmerer's book will replace the Flexner report as THE book on American medical education."—Gerald T. Perkoff, Curators Professor Emeritus, University of Missouri-Columbia School of Medicine
Reviewer: James A. Pittman, BS, MD (University of Alabama at Birmingham School of Medicine)Description: This is a clear, fascinating, exhaustive, and telling book describing the development of medical education in the 20th century. Purpose: The author, one of the leading historians of medicine in the world and practicing physician at Washington University Medical Center in St. Louis, has divided the century into thirds for heuristic purposes, but there are really two objectives: first, to discuss the heroic build-up of the system of teaching physicians in the first portion of the century and second, to alert readers to the changes in medical education affected by the massive rise in research and practice, including recent restrictions imposed by managed care. His thesis is that the emphases on research and earning money from practice have nearly crowded teaching out of the academic medical centers and their medical schools, and that some sort of denouement is occurring with restrictions now being imposed by governmental and private funding sources. Audience: The thesis put forth by the author is likely to be received well by the intended audience — those working in academic medical centers, other interested physicians, insurance companies, policy makers in and out of government, and interested laymen.Features: The author appears to have visited a huge variety of medical institutions and their archives, and to have read nearly everything pertinent to his subject and digested it. This is reflected in the narrative, tabulations, anecdotes, and the nearly 100 pages of closely packed references and commentaries in the notes at the end of the book (well worth reading by themselves). Assessment: This is an attractive, well-referenced, and authoritative book. There is no other historian of medicine so well situated to write this book, which will become the definitive work on the subject.
