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American Medicine and the'Inevitables in Its Future

Ward Darley, MD
JAMA. 1966;196(3):267-268. doi:10.1001/jama.1966.03100160117033.
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As this nation's leadership looks to the future structure and function of its health and medical establishment, it is important to consider those phenomena that will be inevitable. Of course, the most basic inevitable will be change itself. One has only to look back 25 years to appreciate the exponential rate with which change has taken place and, barring a world catastrophe, it is inevitable that both the direction and speeed of this change will continue. The components of this change, all of which are inevitables in themselves, constitute a chain reaction, the links of which arrange themselves in the followingsequence: (1) increasing knowledge, (2) increasing specialism, (3) increasing demands for service, (4) increasing costs of service, (5) increasing shortages of personnel, (6) increasing complexity and efficiency in data processing and communication, and (7) increasing institutionalization (organization).

Much can be said about these inevitables: why they represent inevitables (I offer


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