A Not So Brave New World--Part II

So it came to be that the male juggernaut that had decreed compulsory medical education took the next logical step: more hospitals needed to be built. Hospitals, however, were a far more complicated undertaking then building medical schools. For one thing, they cost much more to build. Maintenance was more expensive. And hospitals required much more land then medical schools did; a medical school could locate itself inside of a basement or garage--a hospital needed room for expansion.

The first hospitals that were built looked at established communities and took over buildings in those communities that could be altered to be hospitals. Sometimes these hospitals fit into the communities where they were placed and sometimes they didn't fit comfortably. The powers that be merely shrugged their shoulders. "We are bringing medicine to the world," they postulated. "The neighbors will just have to adjust."

And at first there was peace surrounding the new hospitals, at least on the surface. All doctors were welcomed to practice within the hospital. Graduates of different medical schools found themselves rubbing shoulders within the four walls of the hospital. There was a sometimes uneasy alliance among the doctors, but they overcame the small irritations by remembering that they were, when all was said and done, all doctors. In many cases an easy camaraderie existed between the doctors, and between their families as well.

Because the doctors in any given hospital would arrive with the teachings and philosophy of their medical school as part of their mental makeup, there were some heavy disagreements as to what procedures and policies should be in affect in a community hospital. But because there was only one hospital to a neighborhood, the doctors were forced to come to a consensus on hospital policy. If doctors differed from hospital policy they were free to run their private practices as they wished, but hospital policy had to be inclusive. Yes, there was some grumbling, but outwardly the doctors presented a united front.

And so things would have continued forever, but the Deans of the various medical schools were not happy.Their influence over their graduates was slowly being diluted, a situation that was intolerable. How best to proceed? They tried proclamations to the neighborhoods where the hospitals were situated but had limited success; there were just too many proclamations, too many conflicting proclamations. People were free to pick and choose among the doctors in the community; no one doctor was dominant.

So, in 2087, an enterprising Dean of a medical school announced a unique solution. Far from the established communities with their egalitarian hospitals, his medical school was building its own hospital. Only those doctors graduating from his medical school would be allowed to practice in this hospital. Thus would be preserved the "right" philosophy that had been inculcated into his students. And it worked. Trained to see themselves as "the best and the brightest and the rightest," graduates of this medical school flocked to the new hospital.

In the great urban centers of the country this model quickly caught on. Where new land to build was not easily available, medical schools formed clandestine committees to take over existing hospitals. The medical school Deans, who were sometimes more politician than doctor, quickly found that exerting pressure on the children of the doctors in a community could achieve what putting pressure on the doctors directly could not: the children came home and preached conformity to their parents. And thus it came to be that a great schism was brought about in hospital care.