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For four years the members of the Committee on Medicine and the Changing Order of the New York Academy of Medicine, and the experts it appointed, studied the problems of contemporary medicine and related fields (hospital facilities, nursing service, etc.). The study was made with a diligence and intensity surpassing by far the work of the usual committee. The result is a series of monographs (e.g., Medical Education and the Changing Order, by Raymond B. Allen) of high caliber and unusual interest. The present volume, Medicine in the Changing Order, is an integrated summary of its investigations and deliberations.
For readers of this QUARTERLY, the present volume is of interest from several angles. It represents an unbiased, careful, factual study of the general problems of medicine today. It is free of propaganda and special pleading. It is an urbane discussion of the realities of many problems of interest to the psychiatrist. The practice of medicine in America, its assets and defects, the impact of economic and social changes on the structure of medical practice, the problems of adequate medical care for the community and the country, are presented nondogmatically.
On the difficult problem of socialized medicine and compulsory national medical insurance, the committee recommends an evolutionary, rather than a revolutionary, program. Its comment is that 'with the evidence of inadequate and unequal medical care so definitely established, it is a natural reaction … to demand an immediate corrective … by legislation. The recommendation made by our committee envisages the development of a slower but much surer plan.' Its many-sided recommendations include a great increase in public health services particularly in rural areas, a more effective use of hospital services, the experimental development of a variety of fixed fee diagnostic consultation services, the extension of voluntary nonprofit prepayment plans, government aid for adequate hospital and health faci