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A Visionary Dean, 44 Years Before Health Care Reform

Gellhorn two

Alfred A. Gellhorn, MD

Compare these two quotations.

First: “Medical want in the midst of medical riches is an unconscionable inequity, and it could be socially explosive.  Good medical care for some of the people some of the time is no longer acceptable; competent medical care for all of the people all of the time is now demanded. . . .” The University of Pennsylvania “has the experience to help lead American medicine into the next great chapter of its evolution: seeing that its health-giving powers get through to all elements of today’s changing population.”

Second: “As a physician, I believe that it is, first of all, a civic and ethical imperative: the primary goal should be to expand coverage for the millions of Americans who have either no health-insurance coverage or very little. . . . Our mission involves curing disease and saving lives, through biomedical research and through expert clinical work. But to be fair, what we do must be available to as many people as possible.”

The second speaker was Arthur H. Rubenstein, MB, BCh, then the executive vice president of the University of Pennsylvania for the Health System and dean of the Perelman School of Medicine. His words come from the dean’s column in Penn Medicine (Winter 2009/2010), which appeared while the Obama Administration was continuing its push for the passage of the Affordable Care Act.

The words of the first speaker seem very much of the same time and the same point of view. But they were spoken nearly 40 years earlier. The speaker was Alfred Gellhorn, MD, then dean of Penn’s medical school and the first director of the University’s Medical Center. Gellhorn and his vision of what academic medicine could achieve were the subject of the cover story of the April 1970 issue of The Pennsylvania Gazette.  The fact that Rubenstein could in some way echo Gellhorn’s imperative –- the title of the article was “To Make Health Care Available to All” –- suggests that the American health care system had not progressed very far.  But as we know, the Affordable Care Act is now in effect, and its outcome is not yet clear.  In the same issue of Penn Medicine in which the dean’s column appeared, Ralph W. Muller, CEO of Penn’s Health System, stated “Although what we will have may be imperfect, it is an important first step toward a focus on higher quality and increased access to health care for the American people.” And for that, Dean Gellhorn, who died in 2008, would probably be thankful –- but demand more. 

Gellhorn arrived at Penn in 1968 after 25 years at Columbia University, and he came with an ambitious vision. According to Mary Ann Meyers, who wrote the profile in The Pennsylvania Gazette, he hoped and expected that a “historic corner will be turned in American medicine during the 1970s.” She noted that Gellhorn believed that “high-quality health care is a birthright” and that such an idea should have a profound effect upon the University’s medical education and research programs.  And of note as the Perelman School of Medicine begins its 250th anniversary year, Gellhorn was also aware of what he called the University’s “significant role in American medical education.” As he put it: “As I looked forward to medical education moving to a new era, it was exciting to contemplate becoming a part of a University that I was confident would maintain its historic role by leading in the development of an equable health care delivery system.”

What was somewhat surprising to a person reading about Gellhorn’s plans 44 years later is that he hoped to broaden and update the school’s scope. Indeed, he appeared to be aware of a growing “generation gap.” “To the current generation of realistic-idealistic medical students, the attainments of their elders, whether measured by recognition in science, personal income, or even clinical skills, are not as highly regarded as in the past because they appear to be unrelated to many of the important problems of health in our contemporary society.” Gellhorn pointed to “the pressing need” to broaden how health care is conceived, to include “not only physical but also mental and social well-being. The time has come to join the existing skills of the medical sciences with those of the social sciences in combating the health problems of our country.” In Gellhorn’s view, that would mean bringing a “renewed sense of humanism” to the task and considering the social and environmental factors that are involved both “in producing disease and in curing it.” 

The dean’s words would not have been out of place in a campus presentation I wrote about last year by Ana E. Núñez, MD, associate dean for urban health equity, education, and research at Drexel University. In the era of high-tech “personalized medicine,” she told Penn medical students that “physicians must be aware of how . . . subcultures intersect with medicine” and that they must pay very close attention to the patients they will be treating, where socio-economic and cultural backgrounds can vary tremendously.

Shortly after Gellhorn arrived at Penn, one of the five hospitals affiliated with the medical school, Pennsylvania Hospital, established a community health center. It was a direction he approved.  The medical school also created a department of community medicine, which offered a basic course to all first-year students in the environmental forces affecting health. As the Gazette article noted, “The students will be able to work in community medicine programs as they develop, and on a volunteer basis they already are assisting the Young Great Society in a health center in the Mantua area of West Philadelphia.”

To help increase the number of practitioners needed to extend health care, Gellhorn expanded the size of each class from about 130 to 150 –- and proposed expanding them to 250 each. His hope was that a larger percentage of all socio-economic groups would be represented in the classes. One of the School of Medicine’s programs brought students from Lincoln University and Morgan State University to the medical campus for the month of January to work with faculty members on a range of projects. According to Gellhorn, the program gave the students an opportunity to develop some scientific skills “and perhaps to see to what extent they’re attracted to the practice of medicine.” And, he noted, some medical schools had used the Penn program as a model.

Again, some of Gellhorn’s initiatives sound very familiar today. For example, there is the Penn Medicine High School Pipeline program (Penn Medicine Winter 2014), which introduces students from West Philadelphia to careers they may not have considered otherwise and helps them fund their college educations. In the obituary published in Penn Medicine, we noted Gellhorn’s focus on collaboration with the local community –- and the fact that the University awarded him an honorary degree in 1993 for his contributions to medicine and to physician education in the service of humanity. Alfred Gellhorn left Penn after five years as dean. His vision for academic medicine was not realized to the extent he had hoped, but neither has it been exhausted or discredited. Today, in fact, the larger enterprise of Penn Medicine has embraced much of the same vision.

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