The role of the hospital in the evolution of elite cultures of medicine

Rosenberg argues that a culture of medicine articulates a unique medical vision reflecting scientific ideologies and perceptions, professional values and rewards, career patterns, and the work context of each generation of physicians (Rosenberg, 1987, p. 7) It might be more accurate, however, to recognize multiple cultures of medicine. This papers traces American hospitals' contributions to three specific aspects of certain elite cultures of medicine. Its first section introduces and explores these aspects transhistorically. They are: a stratified paradigm of the physician-patient relationship, the equation of competence with specialization, and a pattern within a stratified model of medicine called the “Lone Ranger syndrome.” A brief historical profile subsequently highlights changes in the structure and function of American hospitals in the 19th century. The three remaining sections chart the ebb and flow of the prominence and power of these specific aspects of elite cultures of medicine across three historical periods: the late 19th century, 1910–1930, and the post World War II era.