Hello and welcome. I am Dr. George Lundberg, and this is At Large at Medscape.
I had the pleasure of being a guest lecturer in New Orleans at the Louisiana State University Health Sciences Center in June. My hosts informed me that they had notes from the Emma Moss Lecture that I had presented there in 1990. They said I had made predictions about the likely biggest issues in American medicine as we entered the new millennium. They asked me to make fresh predictions from the vantage point of 2014 and suggested that, after the presentation, we could check on my 1990 predictions and see how accurate I was. I agreed.
In 1990, I predicted that the following would be big issues after 2000. I've added my reality check to each prediction.
1. Whatever happened to "the Golden Age of Medicine"? Most American physicians would now say it disappeared.
2. The extraordinary future of technologic medicine. So true, what with personalized, precision medicine and fantastic electronic advances.
3. The role of money in medicine. American medicine has become mostly about money.
4. Sickness insurance. With insurance companies now barred from considering pre-existing conditions, we can have sickness insurance.
5. Do you have a right to basic medical care? This is not yet settled, although most Americans now agree that the answer is yes.
6. Quality and patient safety are...? Still uncertain, but attracting much more attention.
7. The autopsy as a metaphor for quality and trust. This is still a metaphor; not yet resurgent for hospital patients who die.
8. Medical ethics and the uninformed consent. These remain serious problems, every day.
9. Death is normal; pain is not. We are doing better as we grapple with the inevitability of dying, but the strong initiative to control pain is itself suffering from the collateral damage of unintended consequences.
10. The great public health issues of our time:
• Prevention of nuclear war -- we have not had a new one.
• Tobacco -- we are making serious progress.
• Violence -- is raging around us.
• Prevention of disease -- we are making good progress on some fronts.
11. They call it "alternative medicine." It is flourishing, for better or for worse.
12. Whatever happened to the American Medical Association? It lost most of its membership but has stabilized and may be clawing its way back.
13. A solution for the American medical system for the next century: a public/private mix of professionalism, business, and regulation. The Patient Protection and Affordable Care Act is just that, although professionalism remains in short supply.
That is a pretty good list of 1990 predictions. They held up well after 2001, most even until now.
Come back to see us for new, more elaborate 2014 predictions in the next two At Large columns. That's my opinion. I'm Dr. George Lundberg, at large for Medscape.
Medscape Internal Medicine © 2014 WebMD, LLC
Cite this: American Healthcare Predictions From the Past and for the Future: Part 1 - Medscape - Jul 22, 2014.
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