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Annual Oration of 1999

Some Hopes and Predictions for Medicine in the 21st Century

Orator: Peter H. Levine, M.D.

Synopsis of Oration:

Dr. Levine, in the final year of the 20th century, notes the increasingly rapid pace of change in medicine and provides some thoughts on the next century. His presentation is divided into ten thematic sections.
  1. Leadership: More physicians will assume leadership roles and these should adopt a "values-driven" style rather than leadership by consensus or by individual decision. In the values-driven system, the leader seeks broad input from colleagues to develop a set of morals, values, and cultural elements focussed on patient and community needs. Decisions can then be made rapidly by a small leadership team working with these values rather than having to wait for a consensus.
  2. Solo-ship versus Teamwork: A physician functioning alone is no longer possible with the vast increase in information and complexity of patient care. Easy interplay between many different elements of the healthcare system will be required.
  3. Private Practice versus Salaried Status and Specialists versus Primary Care Physicians: This heading is to point out that focusing on the word "versus" is a waste of time and assets. All these modes of practice are compatible but should operate in a framework that can take advantage of the economies of scale.
  4. The Art of Medicine and the Growth of Alternative Medicine: Americans are now making more visits to alternative practitoners than to mainstream physicians. Dr. Levine believes this, in large part, reflects the fact that alternative practitioners may spend more time listening, laying on of hands, and reassuring their patients.
  5. The Effect of Genomics on the Next Century: Dramatic advances in medicine will occur when the human genome project is completed by around 2003.
  6. Information Systems and Their Role: Only those large healthcare systems that make major investments in informatics will thrive in the 21st Century.
  7. The Importance of Teaching: The best way to learn is to teach. Unfortunately, Medicare has made major cutbacks in the support of teaching costs and we must fight to have third party payors include these costs.
  8. Medical Research: During the past fifty years the most important healthcare advances have come from U.S. laboratories and we must not lose our world leadership position in research.
  9. Occam's Razor and the Ethics of Managed care: Asking inappropriate questions, Occam pointed out, leads to answers that lead one astray. Dr. Levine discusses what the appropriate question should be in finding a system that, with limited financial resources, can provide healthcare to an entire community and still maintain the individual doctor-patient relationship.
  10. The Risks and Rewards of Our Calling: Medicine is one of the most personally rewarding fields but faces risks produced by increasing demands and stress on the physician and also by such factors as redistribution of healthcare dollars into the pharmaceutical industry (often with borderline efficacy) and into the malpractice and defensive medicine costs.


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