A Nation in Crisis

It took economic breakdown — the actual collapse of the system — to get America’s attention focused on a crisis which evolved over recent years. Will it take a catastrophic failure of yet another major system — that of health care delivery — for America to address health care reform?

The crisis in health care affects many population segments; in this issue we focus on older patients and the ways in which the health care system can fail them, as well as the root problems that need to be solved for true reform to occur. The clock is ticking as baby boomers move closer toward their “golden years” — which, for many, now are tarnished with insecurity. The crisis is mounting, patient by patient, day by day.

A new federal administration promising aggressive action is a source of hope, but reform will be neither easy nor inexpensive. It involves all Americans and crowds a plate of crises on the national table. Our hope is that this issue of Medicine at Michigan will contribute to a clarion call for reform on behalf of older patients, current and to come, who face uncertain health care resources for their future medical needs.

—Rick Krupinski, Editor

Proper Auscultation

I just finished reading the fall issue of your delightful magazine. However, turning to the photo on page 35, I was shocked to see a staff internist listening to a patient’s chest through a gown. This is the No. 1 no-no in auscultation of heart and lungs. Back in the 1950s such an exam would have brought a stern rebuke from our instructors, especially Dr. (Franklin D.) Johnston, head of cardiology. I realize that history-taking and physical examination have taken a backseat to the sophisticated and expensive profit-producing testing now done, but the history and physical exam done properly are still the foundation of diagnostic medicine.

—David Litowsky (M.D. 1955), Houston, Texas

Editor’s note:
Scott Flanders, M.D., pictured in the photo, agrees with Dr. Litowsky: “The heart should always be auscultated without any clothing barrier. This was not a real patient (he had been previously discharged from the hospital) and the room was full of photographers, family members and hospital public relations staff, which couldn’t afford the privacy he would deserve for a real physical exam. We even discussed the issue while photos were being taken. The problem with the photo is obvious and has been mentioned by many, but we might have received an equal number of comments had we removed this man’s clothes for the picture!”