History of Healthcare Part 10: Welch vs Osler

Two of American medicine's pioneers, and co-founders of Johns Hopkins Medical School, represented a fork in the road.  William Osler, whose scientific humanism pushed back against a healthcare system teetering between commercialism and quackery, created a solution at Hopkins: clinical care, doctors as teachers, patients as teachers, an end to protocols and dogma.  He believed in patient centric care: "If you want to know the diagnosis, ask the patient," he said.  He believed that America was becoming a society of drugging rather than healing.  He believed that nuance and uncertainty were inherent to healthcare, and that there could never be one right answer.  His colleague, William Welch, was a pathologist, a eugenicist, a believer in German medicine, an AMA president.  He did not believe in the importance of patient centered care, rather advocating laboratory medicine that trumped the patient.  He believed in drugs and one-right-answer thinking and he rejected the value of clinical care in education.  He wanted a medical education system run only by full time laboratory faculty, not practicing physicians as Osler had set up at Hopkins.  Welch, in the end, won the day.  Once Osler retired, Welch fired all clinical staff, and imprinted the AMA model upon all of healthcare.  He is indeed the father of American healthcare, but of a healthcare system that embraced eugenics and the medical racial script, that marginalized patients, that created diseases out of numerical norms, and that worked with corporations and drug companies.  If you want to know where our system came from, you only have to understand Welch's victory over Osler.  And if you want to know how to fix the system, you only have to understand and revive Olser.