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Commentary |

The Quest for the Therapeutic Organization

Roger J. Bulger, MD
JAMA. 2000;283(18):2431-2433. doi:10.1001/jama.283.18.2431.
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In this time of apparently wrenching change in the environments in which academic health centers must exist, it is pertinent to ask, What is the single greatest challenge facing these institutions as they enter the third millennium? To answer that question, it is important first to consider several key aspects about this changing environment.

The dramatic changes affecting health care and higher education in the United States reflect much of what is happening in the rest of society. American society is moving from the security of a belief in everlasting material progress (called modernism), based on the principles of the Enlightenment as expressed through the successes of the capitalistic, democratic, industrialized nations, and is entering a time of confusion (called postmodernism), characterized by decreasing faith in the old principles and with no new governing paradigm readily available. Modernism has brought society many advantages, but it does not provide meaning or happiness in life. Former Yale University Provost Jaroslav Pellikan, a noted scholar, has proclaimed the end of total reliance on rationalism and the Enlightenment: "A third intellectual virtue is a sustained, if not significantly chastened, trust in rationality and its processes. For a variety of reasons, such a trust has been challenged by an awareness of its fallibility and its limitations. It seems imperative for the university to develop a deepening appreciation for other ways of knowing and thinking which cannot be accommodated easily to the criteria of the Enlightenment and rationalism."1

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