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Am J Psychiatry 1960;117:385-392.
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Professor of Education (Medical Sociology), Teachers College, Columbia University, New York, N. Y.

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In summary of the impact of contemporary changes on medical personnel and patient care:We have saluted medical-hospital staffs for what they now offer for the health and welfare of potential patients.We faced frankly the great lag between what actually is done and what could be done by a full use of available knowledge and skills.We called attention to the fact that lay dissatisfaction increases and presses for improvements—and may press harder on the health professionals in the future.We anticipated that many improvements in patient care can come by means of better application of the existing knowledge and skills.We expected, also, that improvements in hospital practice are bound to come in one way or another—that in the end society will probably have its way. So we are not pessimists.We anticipated, on the other hand, that such progress in patient care will occur in the face of some opposition on the part of many potential patients and we hoped, by implication, that systematic study of the social factors involved may speed the orderly progress of hospital-patient relationships.We have called attention to six broad changes in the social order that have some bearing on medical trends and staff-patient relationships: population mobility—horizontal and vertical; general lay sophistication; commercialization of the professions; shifts in age composition and disease prevalence in the population; changes from a religious-philosophical toward a scientific orientation; and the growth and spread of organized pressure groups.We have also identified specific changes within medical-hospital practice: vast expansion of equipment and capital investment; growth of institutionalization; increase of specialization (professional and para-professional); the fragmentation of responsibility and sharpening of blame potentials; the rapid growth of prepayment plans, group medical practice, and participation of the government in provisions of medical care.Attention was called also to the fact that new and more challenging concepts of patient care have arisen, expanding the old ideas in comprehensive terms: adding preventive and rehabilitative care to care in the acute stages of illness; calling for team relationships in decision-making and practice; and moving towards group responsibility for the well-being of potential patients.The impact of such trends and developments on the new physician, the hospital of tomorrow, and patient care of the future will probably be great, however difficult to foresee or to measure now. In a sense we find in the present hospital a "house divided in itself." We hold little hope that smoother "public relations" goes down deep enough to resolve many of these change-determined cleavages. They call for statesmanship in hospital practice more than for salesmanship in hospital service. Your psychiatric skills are much needed in the general hospitals. Not your profundities, mind you, but your simple, tried, and tested principles.Finally, how interesting it would be to return to this place and to review again these matters twenty or thirty years hence when today's students in the health professions have come to occupy your present important places—and our children are their patients.

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