spacer Even without a focus on the individual, these improvements helped increase life expectancy by 21 years in half a century - from 47 years for people born in 1900 to 68 years for people born in 1950.

In the second era, many people still died of infectious diseases and other sudden-onset problems such as injuries from accidents. They were just much older when they succumbed, compared to people in the previous era.

Improvements in health came by treating those acute conditions with acute interventions. Penicillin, vaccinations and surgery are examples of such treatments, which are delivered once or over a short period of time.

In the second era, wise doctors like those in Norman Rockwell paintings took the actions needed to improve health. They were trained professionals. They had studied medicine for years. Taking these actions was their job, 10 or 12 hours a day.

Involvement with the patient improved. But patients still might not have been told what their diagnoses or treatments actually were. It wasn't critically important that they have that information. As an example, the doctor gave a shot of the miracle drug penicillin and the patient didn't die of pneumonia. Patients didn't need to know the details to get good results.

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June 19 , 2011

Three eras frame doctor-patient communication

by Elizabeth L. Bewley

This column has pointed out that healthcare, which saves millions of lives every year, is also America's No. 2 killer, due to side effects and complications of treatment. In order to get better results from healthcare, it may help you to know how this unlikely situation arose.

Healthcare is organized to solve the problems of prior eras. In the first era, it didn't have to focus on you personally to save lives. In the second era, it didn't have to consider its long-term effects on you. Today, in the third era, it needs to do both of these things in order to get good results - but the healthcare system hasn't caught up to this fact yet.

In the first era, more than a hundred years ago, people usually died of infectious diseases such as the flu or pneumonia. Big improvements in health came from cleaning up the water supply, improving sewage treatment, and taking other steps to prevent the spread of infectious diseases. The people who drove those actions were trained professionals working in public health agencies.

It is easy to understand why professionals who were focused on sewer systems or water treatment facilities did not repeatedly consult individually with each patient.