Advocacy and community: the social roles of physicians in the last 1000 years. Part II.

Medicine in the 16th through the 18th centuries underwent profound changes -- from its understanding of the human body to its growing significance in the body politic. Key to advances in medicine as well as to the growth of nations was a conceptual shift in the perception of the natural world, which would ultimately provide a methodology for therapeutic advances as well as for the building of wealthy, strong nations.

Advocacy and community: the social roles of physicians in the last 1000 years. Part III.

The 19th and 20th centuries were to witness dramatic developments in Western medicine. The Industrial Revolution was to transform the means by which societies generated wealth. Populations grew exponentially throughout Europe and America as epidemics receded into the pages of history, and clinical medicine -- grandchild of the Enlightenment project -- was beginning to produce long-promised therapeutic benefits for individual patients. As these factors merged, healthcare would be transformed simultaneously into a commodity -- to be bought and sold on the market -- as well as a public good, and even a right, expected by citizens from their governments. Physicians would be called upon to mediate this tension, which would come to define the context of medical practice through the end of the 20th century.

Advocacy and community: the social roles of physicians in the last 1000 years. Part I.

Over the last 1000 years, the practice of medicine in the Western world has been shaped by extraordinary transformations -- in the organizational structures of healthcare delivery, the changing concepts of disease and illness, and the ethical and social issues posed to a growing and diversified profession. Some critical aspects that characterize contemporary Western medicine -- as professionally defined, highly organized and regulated, and scientifically and technologically based -- have emerged only within the last 200 years. For most of its history, medicine was practiced without these distinctions -- but precursors to many current tensions can be traced back to Hippocratic times. In the last millennium, medicine developed in tandem with emerging political ideologies and social structures, and the roles of physicians evolved to respond to the needs of individual patients, the profession, and society at large. As medicine became increasingly effective, it was harnessed into the political objectives of promoting social cohesion and productivity. Professional regulation and social mechanisms for the equitable distribution of healthcare became significant considerations for the profession and society. In this brief 3-part history, we will trace the major organizational, conceptual, and political changes that, together, by the year 2000, created a profession with responsibilities of advocacy for individual patients in concert with attention to the needs and demands of all the individuals in the larger community.