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Department of Surgery, University of Texas Health Science Center, San Antonio 78284-7842, USA.
Am J Surg. 1996 Nov;172(5):398-404. doi: 10.1016/S0002-9610(96)00251-6.
Teaching hospitals, a critical component of medical education and a provider of indigent care, are in crisis. Competition from our own well-trained graduates practicing in sophisticated community hospitals, the rapid development of managed care, federal restructuring of funding, and erosion of our public economic base are important factors. The failure of teaching hospitals is likely to adversely alter medical education and threaten our professional status as doctors and educators as we compete to survive. The problem is identified, but the clear solution is not. My treatise began with the idea that the public recognizes that their teaching hospitals are in crisis. Yet there is some element of public optimism reflected in a Time magazine article that states, "Whatever happens, no one doubts that teaching hospitals will survive." Although neither government nor medicine are widely respected as organized entities, we do have the best medical care system in the world and the most trusted politicians and doctors on an individual basis. We may or may not be able to improve things substantially, but we must try. In spite of difficulties in the process, we will ultimately live up to Sir Winston Churchill's expectations: "The American people will...do the right thing, but only after they have tried everything else."
教学医院作为医学教育的关键组成部分和贫困患者医疗服务的提供者，正处于危机之中。来自我们训练有素的毕业生在先进的社区医院执业的竞争、管理式医疗的迅速发展、联邦资金结构调整以及我们公共经济基础的侵蚀，都是重要因素。教学医院的失败可能会对医学教育产生不利影响，并在我们为生存而竞争时威胁到我们作为医生和教育工作者的职业地位。问题已被识别，但明确的解决方案尚未找到。我的论文开篇提出公众认识到他们的教学医院正处于危机之中。然而，《时代》杂志一篇文章反映出公众有某种乐观情绪，文章称：“无论发生什么，没人怀疑教学医院会生存下来。”尽管政府和医学界作为有组织的实体并未广受尊重，但我们确实拥有世界上最好的医疗体系，而且就个人而言，我们有最受信任的政治家和医生。我们或许无法大幅改善现状，但我们必须尝试。尽管过程中会有困难，但我们最终会不负温斯顿·丘吉尔爵士的期望：“美国人民……会做正确的事，但只有在尝试了其他所有办法之后。”
