David D. Rutstein

David Rutstein was former Chief of Preventive Medicine at Harvard Medical School and Ridley Watts Professor of Preventive Medicine Emeritus.

  • Blueprint For Medical Care

    David D. Rutstein

    Dr. David Rutstein, Ridley Watts Professor of Preventive Medicine at Harvard Medical School, unfolds in this book—written for laymen—a systematic plan for building a sound and functional national medical care program, one in which all the components and modular units are joined into a single structure to provide better-quality and more efficient health care.

    Although the need for a national medical care program is widely conceded to be urgent, legislation has not been forthcoming for lack of a definitive, detailed program. This book meets just that need. As MIT President Jerome Wiesner writes, “... a major reason for the delay in the enactment of national health legislation is the lack of a specific professional and technical plan of medical delivery to serve as a basis of agreement.

    “I believe that Doctor Rutstein's plan could fill this gap. His blueprint proposes a plan for integrating the individual units of a national health program into a complete system. Most important, it makes provision for critical review, testing, and evaluation so that modification and improvement may be effected without delay as experience and research results are accumulated. The plan incorporates a quality control system that can measure the effect of the operation of the separate units of the program on the health of the population.”

    This quality control system is a significant innovation: it enables medical professionals to design, reorganize, and operate full health care programs in regional centers throughout the country that should yield better health for Americans. As feedback from these centers is monitored by the National Center for Health Statistics and the Center for Disease Control under a proposed Federal Health Board, needed adjustments of policy can be effected.

    But the book contains numerous other highly specific proposals, dealing with such topics as the creation of a system of national and regional health units that are professionally independent of the federal and state bodies that fund them –the institutional structure of the hospital of the future—area wide emergency medical care—improved ambulatory care—a new method of payment to physicians and new methods of medical care financing—a solution to the medical manpower muddle—needed changes in the curriculum of medical education—and new developments in information processing and medical communications, including consultation at a distance.

    For all the reliance on computer use and the application of systems theory that the book supports, Dr. Rutstein has by no means lost sight of the personal, human relationships that are an important part of patient care. In urging that the number of medical generalists be increased, he writes that “The heart of the proposed medical care system is a personal physician relationship to offer guidance, reassurance, and support to the patient.... As this blueprint unfolds, it will become clear that it is proposed to increase the number of general physicians, to assign to them the role of 'captain of the team,' and to allocate to them the responsibility for primary, personal, and continuous care for each individual patient.”

    • Hardcover $12.00
    • Paperback $8.95
  • Engineering and Living Systems

    David D. Rutstein and Murray Eden

    “Our knowledge of living systems has been based, for the most part, on the tripod of anatomy, biochemistry, and physiology. The contributions of the physical and engineering sciences and mathematics have been relatively few, and their interrelationships with biology and medicine have been casual ones. Moreover, for the last quarter century, precisely measured social and behavioral science has begun to contribute to our health and to the prevention and treatment of disease. It is the purpose of this book to indicate how the biology and medicine of the future can be built on a foundation consisting of all of these disciplines in order better to understand the nature of health and disease in the individual and to design more viable and complete medical care programs.”

    The proposed program points up the need for an administrative structure to aid the flow of concepts, ideas, knowledge, and technology among those concerned both within and without the university. The kinds of experts needed to bridge the existing gaps between the disciplines are defined. Educational programs are outlined for full-time specialists, research participants, and practitioners in both engineering and medicine. A careful description is given of the stepwise process, including interaction with industry to apply development in the engineering sense to biology and medicine. A detailed example of the application of systems analysis and operations research to the development of a specific medical care program is included.

    This book examines the general principles learned during the exploration of a joint program between Harvard University and the Massachusetts Institute of Technology, which was summarized by the authors in a Report to the National Academy of Engineering. The authors recognized the impossibility of providing specific recommendations for the future in the many fields comprised by engineering and living systems. Cooperation was obtained of outstanding experts on the two faculties who prepared sixteen task group reports under the following headings: artificial internal organs; bioengineering curricula; biological control systems; continuing education; diagnostic instrumentation; diagnostic processes; image processing and visualization techniques; medical care microsystems; neurophysiology; organ and cell culture and storage; physiological monitoring; physiological systems analysis; regionalization of health services (macrosystems); sensory aids; skeletal prostheses; and subcellular engineering. The task group reports, included in toto in this book, provide the documentation for the general conclusions of the authors.

    This book supplements existing medical programs with a new research approach to increase fundamental knowledge, and points the way to better medical care through more efficient application of engineering, technology, and systems development.

    • Hardcover $25.00
  • The Coming Revolution in Medicine

    David D. Rutstein

    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.

    • Hardcover $9.95
    • Paperback $2.95