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(Circulation. 2000;101:2325.)
© 2000 American Heart Association, Inc.

Special Report

Closing the Gap in Quality Health Care for Americans

Presented at the 49th Annual Convocation of the American College of Cardiology, Anaheim, Calif, March 14, 2000.

Kenneth I. Shine, MD

From the Institute of Medicine, Academy of Sciences, Washington, DC.

Correspondence to Kenneth I. Shine, MD, President of the Institute of Medicine, National Academy of Sciences, 2101 Constitution Avenue, Washington, DC 20418. kshine@nas.edu

Key Words: quality • population • prevention • systems

	Introduction

 
My subject tonight is the dichotomy between the success of individual physicians and what I believe to be the failure of our profession to assume a true leadership role in furthering the health of Americans. I believe that there is a narrow window remaining during which professional leadership is possible, but I believe even that window is beginning to close.

Health care is about access, quality, and cost. Unfortunately, organized medicine lost the opportunity to provide real leadership in areas of cost and access. The profession has been reactive, if not reactionary, as well as defensive, complaining, and often whining, instead of showing leadership in the public interest. As the cost of health care escalated for >3 decades, we, as a profession, had an opportunity to seriously control the rate of rise of costs in health care. Instead, we added one technology after another, often without replacing the previous technology. I am still professionally embarrassed by an experience I had several years ago in which I argued at a program of Continuing Medical Education that 90% to 95% of patients with mitral valve prolapse could be evaluated with a careful history, a thorough physical examination, and an ECG. I was attacked by several members of the audience not on the basis of scientific merit, but because I was "taking away [their] bread and butter" by not recommending an echocardiogram, treadmill test, and Holter monitor for each suspected patient; these patients constituted perhaps as many as 6% to 8% of the . . . [Full Text of this Article]

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