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Part IV: Reformers in medical education and practice: Effect of managed care organization in the United States



Part IV: Reformers in medical education and practice: Effect of managed care organization in the United States



Canadian Journal of Plastic Surgery 11(2): 90-94



Part I (Can J Plast Surg 2000;8:25-29) established that standards of professional practice shift constantly. When a standard falls short of professional expectation or when a physician becomes more concerned with financial gain rather than patient care, society needs the action of a reformer. Parts I, II (Can J Plast Surg 2001;9:59-68) and III (Can J Plast Surg 2002;10:103-108) covered 500 BC to 1970 AD and comprised 31 physicians who introduced innovations in medical knowledge or medical philosophy. Part IV deals with a time in which new conditions have been imposed on medical practice. In the United States, medical education and practice felt the repercussions of financial institutions participating in health care management. The reformers were scientists who conformed to our definition of 'reformer': a person whose action restored, reshaped or advanced the structure or ideology of medical practice. This survey demonstrated that the reforms were accomplished by scientists possessing critical judgement and analytical qualities that enabled them to influence the direction of medical education and practice. In the last 20 years, financial institutions imposed different criteria that may require future reformers to reestablish lost objectives. Reforms have been achieved through intuitive leaps, alterations of conventional practice, painstaking research or administrative restructuring. The present health management in the United States requires new solutions. Dans la 1re partie (Can J Plast Surg 2000;8;25–29), il a été établi que les normes en matière de pratique professionnelle évoluaient constamment. Lorsqu’une norme ne répond plus à une attente professionnelle ou qu’un médecin se préoccupe davantage de son profit financier que des soins aux patients, la société a besoin d’un réformateur. Les 1re et 2e parties (Can J Plast Surg 2001;9;59–68) ainsi que la 3e (Can J Plast Surg 2002;10;103–108) couvraient la période de 500 av. J.-C. à 1970 et faisaient mention de 31 médecins qui avaient innové dans le domaine de la philosophie médicale ou des connaissances médicales. Quant à la 4e partie, elle porte sur une période où la pratique de la médecine est soumise à de nouvelles conditions. Aux États-Unis, l’enseignement et la pratique de la médecine ont subi les répercussions de la participation des institutions financières à la gestion des soins de santé. Les réformateurs étaient des scientifiques qui correspondaient à notre définition de « réformateur », c’est-à-dire une personne dont l’intervention a rétabli, réorganisé ou amélioré la structure ou l’idéologie de la pratique de la médecine. L’étude a montré que les réformes ont été apportées par des scientifiques qui possédaient le jugement critique et les capacités analytiques nécessaires pour influer sur l’orientation de l’enseignement et de la pratique de la médecine. Au cours des vingt dernières années, les institutions financières ont imposé divers critères qui nécessiteront probablement l’intervention de futurs réformateurs pour rétablir les objectifs oubliés. Les réformes se sont réalisées de différentes façons : par l’intuition, la modification des pratiques usuelles, les recherches laborieuses et les restructurations administratives. Aux États-Unis, la gestion actuelle des soins de santé a grand besoin de solutions nouvelles.

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Accession: 054870584

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PMID: 24222993


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