As I wasreading about the early years of the Department of Psychiatry of the PerelmanSchool of Medicine recently, I came upon a surprising case of anticipation. Learningabout a new program -- in 1949 -- reminded me once again that some ideas are goodenough to go around more than once.
In Two Centuries of Medicine: A History of TheSchool of Medicine, University of Pennsylvania, George W. Corner, M.D.,Sc.D., LL.D, covered an immense amount of material in the space of some 320pages, not counting notes, references, and index. The school’s foundingoccurred in 1765, when John Morgan read his Discourseupon the Institution of Medical Schools in America, at the Commencement ofthe College of Philadelphia. It was that presentation, quickly issued inpamphlet form, that led that same year to the establishment of the firstmedical courses in the nation. At the other end of the book was a glance atwhat Corner called “the past twenty-five years” -- that is, up to 1965, when thebook was published. It was a program proposed during that period that caught myeye.
As Cornerdescribed it, Penn’s curriculum was undergoing changes at the time, primarilythrough scientific additions, but he also singled out two programs “aimed atbringing back something of that direct contact with ailing human beings outsidethe school which was the advantage of the old apprenticeship system.” In 1949,Kenneth E. Appel, professor (and later chair) of psychiatry, and John McK.Mitchell, professor of pediatrics and dean of the school, “suggested a novelmeans of helping medical students to learn the physician’s role in family andcommunity life. . . . [T]he Family Health Advisory Program initiated byMitchell and Appel was unique in that it begins in the 1st year ofmedical study and introduces the students to the whole range of medicalproblems in underprivileged households.”
Eachstudent who elected to take the course was assigned to a family for whom heserved as “health advisor” for two years or, if he chose, through the wholefour years of medical school. (The “he” was Corner’s word, a choice recognizinghow few women attended medical school at the time.) “Observing the same groupof people through a long period, in all their reactions to illness and otherstresses, he advises the family about services available through the hospitaland other communal agencies and translates to these people the diagnoses madeand the treatment prescribed by the hospital staff.” Here, “translate” haslittle to do with the current “translational” but is meant literally: puttingwhat is said into “plain English” that patients could understand.
Corner’s history ended too soon forus to know what happened to the program, and it does not appear in the later Innovation and Tradition at the Universityof Pennsylvania School of Medicine (1990). But in certain ways, the FamilyHealth Advisory Program resembles a later program developed by the School ofMedicine. The Longitudinal Experience to Appreciate Patient Perspectives (LEAPP)program was launched in 2004 and is still going strong. First-year students areassigned in pairs to patients with chronic illnesses. They follow the patientsand their families for three years, in contact with the patients in their homes(where, for instance, they may go over a patient’s prescriptions), in theirdoctors’ offices, and in the hospital, if that step is necessary.
As PaulLanken, M.D., professor of medicine and medical ethics and associate dean forprofessionalism and humanism, told PennMedicine magazine soon after the program began: “Most people don’t think ofhow difficult the first year of medical school can be. The students are askingthemselves, ‘Am I sure I want to bein this med school business? I’m not seeing patients at all.’ They’re sittingin lecture hall and labs for seven, eight hours a day -- that is not why theyare in medical school.” What these students were seeking is the “directcontact” with patients that the earlier program was designed to provide.
The LEAPPprogram was considered unique both because it involves first-year students (asthe earlier program did) and because it is required of all medical students (whereas the earlier program was an elective).But the resemblances are strong in that both provided early clinicalexperiences and sought to enhance humanism and professionalism while focusingon the patient. LEAPP students report building unique relationships with theirpatients while learning about the larger context of illnesses and their effectson families.
A similarcase: students from the Perelman School have been serving the community byhelping to staff clinics in West Philadelphia: the University City HospitalityCoalition (since 1984) and the United Community Clinic (since 1995). Withstudents and staff from other professional schools, they offer screenings andmany other free health services to those who may not otherwise receive suchcare. What I learned when Penn Medicineran an article on these clinics and the students who help run them is that Pennmedical students had organized something very much like the community clinics50 years earlier.
Back in1949, the impetus came from members of Penn’s Christian Medical Society, whoestablished clinics for the homeless at the Central Gospel Hall Mission and atthe 8th Street/Wayside Mission. As a publication at the time put it,they were “providing care and thoughtful treatment” to the needy. Soon, studentswho were not part of the Society were permitted to join in providing care. Astoday, the students in 1949 had physician guidance. In fact, the secondgraduate director of the earlier clinics was C. Everett Koop, M.D., the futureSurgeon General of the United States, then an assistant professor of surgery atPenn and surgeon-in-chief at The Children’s Hospital of Philadelphia.
Good ideascan have different incarnations at different times.