Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries.
“In one respect, the comercial nature of professional practice was more forthrightly acknowledged in America than in England. Under an ancient legal fiction, English law regarded the services of physicians as wholly philanthropic. While surgeons and apothecaries could sue for their fees, physicians could not. Similarly , the low-ranking English attorneys could sue clients for payment, but he elite barristers were presumed to be above material motives. Like the gradations of status among practitioners, these presumptions never successfully crossed the Atlantic. \citep<><pp.\ 61-62>{starr:82}”
“Cathell's standard for judging the value of any aspect of a physicians' behavior or personality was the effect it would have on public opinion. This concern reflected the situation of the average doctor, who depending for his livelihood on public favor, rather than the judgement of his professional brethren or bureaucratic superiors. Because most physicians were independent general practitioners, doing basically the same kinds of work, they acquired business through a lay referral network, rather than from colleagues, as do specialists. or from organizational affiliations, as do physicians employed by institutions. page 86”
“Cathell's guide portrays physicians as facing a hostile, skeptical, and treacherous world. They had to take precautions against colleagues who might steal their patients and be on guard against "jealous midwives, ignorant doctor-women and busy neighbors," who spread malicious rumors about physicians. Even patients were a threat as potential competitors. At one point, Cathell suggests various ways for physicians to conceal the contents of their prescriptions." page 87”
“"deliberate artifice is the weapon, not of a powerful profession, but of a weak one, which has no confidence in its own authority." page 88”
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