The Coming Revolution in Medicine notes the defects in our medical system as it is presently constituted and sketches out a series of ideas for necessary and immediate improvement. It is an energetic, urgent book. In Dr. Rutstein's words, “The consequences of not planning well for the future of medicine are too grave to contemplate.” The Coming Revolution in Medicine is an attempt to avert those consequences; it deserves wide and enlightened public and professional attention.
The book begins with one central fact: in spite of our mushrooming medical research program, life expectancy and infant mortality statistics – our most reliable indices – do not indicate a commensurate improvement in our national health. During the interval from 1959 to 1966, the life expectancy of males in the United States dropped from 13th to 22nd place among the countries of the world; over the same time span, the life expectancy of females dropped from 7th to 10th place. Infant mortality rates improved so little from 1959 to 1965 that the United States slipped from 11th place to 18th among the countries of the world. Dr. Rutstein's purpose in citing these and similar statistics can be stated simply: flat figures are an effective means of alerting the public to a critical situation. The business of this book, beyond indicating what the weaknesses in our present medical system are, is to propose an outline for the progress that must be made.
Dr. Rutstein sees the need for a complete reorganization of the delivery of medical care. The first step can be taken immediately: the systematic application of operations research to the tangled and repetitive pattern of existing medical care. A set of standards for optimal performance of the medical enterprise must be identified; data on available medical resources must be gathered. These will be used to devise a model that will produce an optimal division of labor in which diversified talents and specialized training will be put to the most effective use.
In addition, medicine must assimilate discoveries made in science, technology, and mathematics. Computers will act as information clearing houses in the diagnosis of disease and as administrators of a vast and unified medical network; feedback mechanisms will control blood pressure and other physiologic functions; laboratory testing and analysis will be automated; above all, research in the physical and mathematical sciences will be systematically applied to the solution of medical problems.
Among the immediately visible changes will be a reallocation of the physician's duties – some delegated to trained technicians, others assumed by machines – so that the physician can spend all his working time with problems that require his special education and talents. In effect, this will produce more doctors to treat an expanding medical public.
The Coming Revolution in Medicine calls for conscientious and intelligent planning to produce a system whose success will be measured solely by the health of its patients. In his last essay, Dr. Rutstein proposes his own plan, a series of guidelines to be used in overcoming the major obstacles to the improvement of the national health. His tack in approaching the problem is to plan for the highest quality in medical care without regard to the economics of hospital bed space and research allocations—then scale the system down to fit economic realities.
