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If, as Socrates stated, “the unexamined life is not worth living,” the “unevaluated” health care system places both physicians and patients at risk. From the dawn of medical practice until very recently, medical interventions (from blood-letting to medicines) were used with little scientific support, and individual practice was dominated by dogma rather than data. The growth of scientific medicine in the 20th century, understanding of the causes of disease, medicinal chemistry to make new medicines, clinical trials to evaluate their effectiveness and side effects, and disease epidemiology heralded a new era of “rational” medicine. And yet, Dr. Jack Wennberg and his colleagues, as they established the Center for the Evaluative Clinical Sciences (CECS) at Dartmouth Medical School, realized that practice varied widely and was often determined more by where a physician trained and chose to live than by data about proven effectiveness of methods.
The Dartmouth Atlas of Health Care, systematically documenting differences in patient care around the United States, is now regarded as a classic. Variations in clinical practice, use of resources and, most importantly, patient outcomes are now examined with an aim of improving health care delivery. Dr. Wennberg and his colleagues have been pioneers in this field. The current crises in health care access and financing now make the work of the CECS at Dartmouth all the more important. For Dartmouth students, the presence of the CECS translates into the opportunity to participate with clinicians, economists, anthropologists and others on the faculty in work that has significant impact on public policy.
From programs such as “shared decision making” at Dartmouth-Hitchcock Medical Center that explore new paradigms for helping patients to be active partners in deciding about health care options, to the newly accredited Masters of Public Health program, the Leadership Preventive Medicine Residency program, the Outcomes Group, and the many faculty engaged in collaborative work across the disciplines, the CECS is designed to do exactly what the name implies, produce leaders who will transform medicine in the United States and beyond.
Stephen P. Spielberg
Dean, Dartmouth Medical School
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