CH. 4

My largest reaction toward this chapter is in the descriptions Starr provides in "The Triumph of the Professional Community." The best summary of the section for me is that it is all too funny. Yes, funny.

There is something humorous about observing how childishly private practitioners squabbled to all get a place on the wagon. It reminds me of toddlers crying because some other child had something they didn't. Only in this case, there is no parent to say, "Well I don't care what so-and-so got."

I would even go so far as to say that the descriptions of the concerns and criticisms of private practitioners are downright adorable if it wasn't for the fact that they were predicated on a genuine seriousness as grown professional men. It is that very fact that makes the description sobering in some way, leading me to feel incredulous as I step back and look at the situation.

While Starr's comparisons to the European movement of medicine happening concurrently with the American movement always casts a tarnishing light, never before has he made the American movement look quite so immature, hypocritical, and childish. It is through Arpad Gerster's quote that he accomplishes this so poignantly: "They must be shown, however, that the hospitals do not exist mainly for the indiscriminate benefit of the medical profession, but are here, first, for the benefit of the patients, and secondly for that of the community."

Though Gerster ultimately speaks to the necessity of economic reform, his observations (including those not mentioned above) clearly cast the American controversy as petty and self-involved. The irony is that all this is of greatest concern in a profession meant to be concerned for others.

It becomes less and less surprising, though, since Starr has made it very clear that the American medical movement was largely concerned with itself as a profession first and foremost, rather than as a calling to serve the people. And though it shouldn't be surprising, I cannot help but feel some level of disappointment as I read about the back-scratching, the competition, the fervency for status as associated with the hospital as an institution and the ultimate transformation of hospitals as "instruments of professional power." It feels as though one more testament to service falls to the ever insatiable stomach of status, power, and control.

Rather than being concerned for their ability to serve their patients, doctors were much more concerned with gaining more prestige and viewed the hospital as a ladder or cash cow. Even the rationalization of inequity to receive training and betterment through education seem like thinly veiled excuses to obtain the true goal of privilege and advantage.

In fact, the seemingly incessant demand for access and advantage for all at the most likely well know cost of quality and service of the hospital to patients is like a retelling of the famous King Solomon parable, with American physicians and European physicians (or those who understood the need for some exclusivity) as the two women fighting over the baby. While one woman was content to have any part of the child regardless of the cost to the child itself, the other is concerned primarily for the welfare of the child. It is only because these are grown men that I classify this as almost savage rather than childish.

I guess it is good to reflect, then, on why I find this so humorous. Is it funny because it's funny? Or because it's one big joke?