In 1682, William Penn, an English Quaker, founded the city of Philadelphia as the capital of his Pennsylvania Colony. 83 years later, in 1765, Drs. John Morgan and William Shippen convinced the Trustees of the College, Academy, and Charity School of Philadelphia to found the first medical school in the then-colonies on the eastern seaboard of North America—modeled on the University of Edinburgh, where they had trained. When the Medical School was founded in 1765, the College and the Medical School became a university, although the term “university” was not added to the institution’s official title until 1779.
At the first commencement, June 21, 1768, ten medical students received their M.B. degrees. (The College granted the first M.D. degrees to four of these men in 1771.)
Two hundred years later, in 1968, my class graduated from that same medical school at the University of Pennsylvania, and last weekend, 250 years later, we celebrated our fiftieth reunion. Perspective comes from such an event.
Individual lives, and deaths, occur. The patients, the teachers, and some of the classmates from whom and with whom we learned so much are gone. Soon we—with all the fragile neuronal connections that we treasure as our professional knowledge and skills—will also return to the dust. But the institution continues. What most concerns our class now is what that institution will look like after another half-century.
Philadelphia and its 1.5 million inhabitants could be vaporized in a thermonuclear holocaust, could be flooded by warm rising seas, or could fall victim to some other unpleasant end. But for the foreseeable future, our civilization, the city, and the university will most likely muddle on.
What can’t muddle on is our way of doing health care. From my experience in the US Navy and from visits to institutions all across the country representing Janssen Pharmaceuticals, I know that good medical care does not require the opulence, the cavernous spaces and grand edifices, that we see in major hospitals today.
What do we need to really do our work as doctors? Accessible simple, sturdy well-lighted buildings with good heating and cooling – easily cleaned surfaces – basic hematology, chemistry, and microbiology labs – a couple of reliable X-ray machines – a delivery room and an operating room – a few rooms for overnight stays –a basic food-service operation— a functional record system – a well-stocked pharmacy – high-speed internet, that’s all. Oh yes, and a place to send the patients when that simple facility can’t handle their problems. No questions asked.
What I’m describing could exist. Should exist. If we had a system where every person in the country had low-cost insurance to cover basic immunization and preventive care, maternity care, trauma, and out-patient primary care, then such places would exist. They would provide the network of referrals that research universities and their academic medical arms must have to do their work.
Every single one of us has benefited from what Penn, Harvard, UCSF, Stanford, and the other 137 accredited MD-granting institutions and 31 accredited DO-granting institutions in the United States do. We should help to fund them through taxes, grants, gifts, and health-care insurance that helps to pay for their services.
But we would also all benefit from extending basic care to our whole population. Make no mistake, breakthroughs in science will come; brilliant younger people are hard at work in their labs. My hope, as I left Philadelphia, was for progress in how we deliver care.