Health Manpower, 1970

Senate Health Subcommittee Testimony
September 2, 1970, St. Louis, by

Max Pepper, M. D.,

Professor and Chairman

Department of Community Medicine
St. Louis University

School of Medicine

We are trying to provide educational experiences for student physicians which will reinforce and nurture one of the great natural concerns that most of them have when they enter medical school: the passion for people. We believe that the most important workshop for the cultivation of this passion and the acquisition of the many skills necessary to make it effective is in the community itself. The finest teachings of clinical medicine have always stressed that the best source of learning for the doctor is the patient himself. We hold that the natural extension of this precept for a preventivelyoriented social medicine is that the best source of learning is the community, which includes patients and their families and also potential patients and their families the whole network of people who live and relate to each other in a common setting. Thus, our approach to the very real health crisis is an ecologic one. The now oft-quoted phrase that "war is too important to leave to the generals" has a very special meaning for us. The importance of forging partnerships between providers and consumers of medical and other health care services goes beyond the obvious need in a democratic society to involve all who are vitally concerned with matters of public policy, which clearly health care has become. To us, the consumer is a "general" in his own right, with a very special kind of expertise in the how, when, what and where of his hurts, and in defining those hurts in relationship to his total life in the community.

Health care providers desperately need the input of this kind of expertise if they are going to define and solve health problems humanly and effectively. To date, little has been done in a systematic way to integrate all the expertise resident in any human community with the staggering knowledge explosion in the bio-medical sciences. This is a mission of community medicine.

In order to approach this mission successfully, doctors and other health care workers must approach the community prepared to adopt reciprocal roles: they must be both learners and teachers, and must develop interpersonal and social skills in organizing, communicating, collaborating, and cooperating with just plain people.

We are experimenting with models of extending our medical educational enterprise into the community environment, and developing the necessary partnerships with a number of neighborhoods in order to accomplish this. Our venture includes payment to non-professional community residents who "tell it like it is" both by participating in didactic sessions in our medical school halls, and in field work experiences in the neighborhoods.

If we are going to be successful in forging and maintaining such alliances, and utilizing the great reservoirs of talent in the community-as-University, new sources of funding will have to be made available, from both the public and private sectors of our economy. If our society really wants the kind of responsive and responsible community physicians and other health workers that the growing recognition of the health crisis indicates are necessary, we must systematically remove all the barriers we have created to equality of access to entering the health professions, and to receiving health care services. level of scholarship and other financial assistance available to medical and other health professional students to pursue their endeavors is a matter of

The

national shame. That we as a nation-community participate through inaction in perpetuating the barriers to readily accessible and available comprehensive community health care for all our people should be a matter of national out

rage.