Did Weir Mitchell anticipate important concepts in ambulatory care and clinical epidemiology?
During the decade from 1977 to 1986, four models of care pertaining to ambulatory medicine and certain aspects of clinical epidemiology were proposed. All were concerned with the frequently heard accusation that medicine was becoming dehumanized by being overly dependent on powerful new technologies. Some of the authors went so far as to suggest that the view, according to which medical science must restrict itself to "hard" data of the kind provided by the serum multichannel analyzer, should be considered outdated and, in fact, unscientific. Their plea was to develop a science of the clinical encounter that would shift the emphasis from explication to prediction and management, the latter term being virtually synonymous with decision making. For this change to come about, they wrote, it would be necessary to collect "soft" data on such subjects as family relationships, psychic traits and states, perceptions of life quality, patient expectations and many others. We believe that some of these subjects as well as the models themselves were anticipated in the writings, both medical and fictional, of Weir Mitchell, nearly a century earlier. This paper, after presenting a brief overview of the career of a colorful and commanding figure from the annals of American medicine, will seek to illustrate his extraordinary farsightedness as a practitioner of primary care and his relevance for some aspects of clinical epidemiology. Because the attempts to link his ideas to modern concepts are ours, we accept the possibility that, here and there, we may have read things into his writings that he did not intend.
Biderman
Aya
A
Department of Family Medicine, Ben-Gurion University of the Negev, Beersheba, Israel.
Herman
Joseph
J
D000553:Ambulatory Care / Q000266:history*; D004813:Epidemiology / Q000266:history; D019317:Evidence-Based Medicine / Q000266:history; D006293:Health Promotion / Q000266:history; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D009462:Neurology / Q000266:history; D018802:Patient-Centered Care / Q000266:history; D015990:Placebo Effect; D014481:United States