Healing the social contract between physicians and the public
Sweeping reforms at the Case School of Medicine this year could make the school a more effective supporter of healthy, sustainable communities — both in Cleveland and around the world.
In a visionary white paper, "Case School of Medicine and Health: A Proposal for Radical Reform of Medical Education," medical school dean Dr. Ralph Horwitz critiques the "deeply rooted alienation" between medicine and public health in the American medical system. And he calls for the school to be re-invented as a school of medicine and health that "will challenge the profession of medicine to re-imagine itself as responsible not just for the care of patients with disease, but also for the prevention and control of diseases in individuals and communities, and ultimately for the health of people in the United States and across the globe."
Horwitz writes, "The social contract between physicians and public has long been eroding with physicians being perceived as putting their own self interest ahead of the interest of their patients and the larger community. By reinventing our curriculum and orienting our philosophy toward improving the health of the American people, we will help students at the Case School of Medicine and Health learn to meet their obligations as professionals not just to the health of their own patients, but to that of the community, society and our health care system."
Although Case's recent financial troubles could delay some of the reforms (see this article in Crain's Cleveland Business), the new curriculum is set to roll out in 2006. It will be exciting to watch how a major medical school shifts to a focus on health promotion and civic leadership.
Below are excerpts from the Horwitz white paper. Read the complete paper here (PDF, 31KB).
Just at the moment in time when the American people have recognized the urgent importance of a healthcare system that integrates Medicine and Public Health, policy makers have come to realize the deeply rooted alienation between the two professions. Medicine and Public Health are separated in education by different philosophies, content and modes of instruction; in practice by different goals, delivery systems and authority; and in public support by different levels of investment in infrastructure and societal appreciation. Events and circumstances of the past decade, including emerging and re-emerging microbial diseases, the growing importance of chronic diseases, persistent deficiencies in the quality of medical care and clinical decisionmaking, and the specter of public emergencies linked to acts of terror, have all emphasized the need for a renewed investment in public health education and infrastructure. These recent occurrences, in addition to the looming shortage of caregivers for the elderly and the increased focus on international health, provide a clear impetus to create a health care system integrated across medicine and public health, one that begins by reuniting the disciplines of public health and medicine into a single, complementary program of study.
To meet this objective, Case Western Reserve University (Case) proposes to create a School of Medicine and Health with the goal of enabling the professional integration that must be a core strategy in addressing the current crisis in the inter-professional relationships between medicine and public health. Through our recreation of the medical school, we will educate physicians to understand the interplay between the biology of disease and the social context of illness; between the care of the individual patient and the health of the public; and between clinical medicine and population medicine. The physicians who emerge from this experience will be individuals whose leadership in science, practice, and health care policy will reflect the interplay among the most enduring and salient themes in health and health care...
The curriculum of the new School of Medicine and Health will reflect our commitment to an integrated philosophy for medicine and public health. Epidemiology, quantitative methods, disease prevention, quality assessment and improvement, population medicine, social determinants of disease, health promoting and health damaging behaviors, all must be inserted seamlessly into courses that provide the core experiences of Medical School...
Every student at Case will develop an understanding of organizational structure and behavior and the core leadership skills that are needed to instigate change in our local and national health care delivery systems. These skills will be taught in special courses designed for medical students by the faculty at the Weatherhead School of Management who are national authorities on these topics...
Case has a further advantage in its efforts to create a new School of Medicine and Health through its relationship with the City of Cleveland and its Department of Public Health. Cleveland is a city that typifies America’s urban communities in its demographics, size, economics, and health. In an effort to improve the health status of Cleveland residents, the University has declared its intention to partner with the City. As a first step in this process, the University has offered the City a building on the Case campus, adjacent to the Medical School, where it can relocate its Department of Public Health. In addition, the University is working with the City to recruit a Commissioner of Public Health who will hold a senior faculty appointment at Case. By placing the City’s Department of Public Health in close proximity to the students and faculty of Case, we will not only bring issues of public health to the forefront in the academic community, but also offer our students experiences in public health practice that will improve the health of Cleveland residents. Our philosophy will also require us to work closely with all of the other graduate and professional schools at the University (Law, Business, Engineering, Dentistry, Nursing, Social Work), as well as the College of Arts and Sciences where we are developing an undergraduate major in Public Health Policy and Practice...
The failure of physicians to learn the fundamental concepts and methods of public health has had numerous consequences. Physicians must be one of the “early detection” systems for new and reemerging diseases, yet few physicians are prepared to function effectively in this role. The public health infrastructure in local and regional communities has atrophied in part because of the disinterest of physicians in the integrity of community-level health services. And physicians are more likely today to advocate for their own self-interest (e.g. malpractice reform and payment rates) than the national interest (e.g. 45 million uninsured and widespread health disparities).
