COMMENCEMENT ADDRESS
UNIVERSITY OF LOUISVILLE
SCHOOL OF MEDICINE
CLASS OF 1986
Charles Smith Jr., MD
(Ed. Note: This address was so prescient that Dr. Smith, senior internist and medical historian, submitted it this summer, and rightly so.)
D
ean Kmetz, Members of the Faculty,
Graduates, Family and Friends,
Frank Lloyd Wright was once
called to testify in a trial and when asked to
state his name said: “Frank Lloyd Wright,
world’s greatest living architect,” to which the
bailiff replied: “You didn’t have to say that.”
Wright replied: “Yes I did, I was under oath!”
That’s where you are! You’re good! The faculty has prepared you
and you’re more prepared than any of your predecessors were for
your profession.
Of course, we’ve always been pretty good. Luke, a physician, wrote
more of the New Testament than anybody else, for those who are
interested. My associate minister, a former newspaperman once
said: “Yeah, he wrote more than that, but he was a doctor and they
couldn’t read his writing.”
But to moderate my assessment, my mother sent me a copy of
Poor Richard’s Almanac when I started practice. One aphorism was
circled: “God Heals and the Doctor takes the Money.”1
Rosemary, my wife, points out from time to time that it was
probably about 1910 before your chances were better, rather than
worse, if you visited a physician for help.
You are good and I only have one other admonition for you.
Read the Complete Works of Sherlock Holmes2 for the power of
observation taught by Dr. Conan Doyle, and Cushing’s biography
of Osler simply because he wrote that Pulitzer-prize winning tribute
to an internist by a surgeon.3
As you leave today, I feel I should share with you certain ideas
about the medical system as currently developed in this country.
This involves three issues: quality, access and cost.
First, quality came to American medicine in the form of the
Flexner Report developed by a Louisvillian for whom the very
street on which our Medical School stands, is named: Abraham
Flexner.4 This assured higher-quality education in medical schools
and established the teaching of medicine at the bedside on the wards,
the John Hopkins system.
Next, access was achieved by the Committee on the Costs of
Medical Care, 1928-1932.5 A few short years before, the American
Medical Association itself had favored a system of socialized medicine as in Bismarck’s Germany or Lloyd George’s England. But
this committee, in 4 years and 30 volumes, developed the idea of a
monthly prepaid fee for health insurance and achieved access for
the bulk of Americans.
The original idea was to spread the risk across all of society and
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