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A century ago this year, the Flexner Report of 1910 described the largely deplorable state of American medical education.1 The Rockefeller Foundation spent decades and a lot of money improving these schools.2 Those schools that did not meet the new standards closed their doors. By 1950 the Foundation leadership asked themselves if their successful efforts to improve education had, by then, actually changed the real practice of medicine for average Americans. It was decided that Osler Peterson was the person to go and see. Osler Peterson MD was, at the time, on the Rockefeller Foundation staff. He was seconded to the University of North Carolina where he undertook to watch the actual practice of medical care provided by a sample of 102 primary care doctors in that state in order to judge the quality of care they were providing. He and his colleagues reported their observations in a special supplement in 1956, of the Journal of Medical Education.3 As a result, this mild, curious, scholarly man made a lot of enemies among these practitioners. However, in later years, and in spite of this experience, he was willing to take on organised medicine over national health insurance and the American surgical establishment.
Primary practice in North Carolina
Osler Peterson must have appeared an odd duck to these practitioners, but letters of introduction, being a physician and southern courtesy opened these doors. The doctors were interviewed, their medical school grades obtained, offices visited and their practice watched by observers who, as physicians, knew what they were observing. This is not a low-cost data-collection method, which is one reason it is so rarely done. Each practice was given a grade on a five-point scale of quality. Eighty-eight practices were actually observed. The observations were grouped into six domains: clinical history, physical examination, use of …
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