Second Opinion

The emergence of the University of Louisville medical center as a significant partner and even leader of what I believe is the best medical address in the region has been a slow but steady undertaking over the past 35 years.

Having been part and parcel of both the successes and the failures, these perspectives may be a useful addition to Volume 1, Number 1, of this journal.

Building a foundation

There were certain events in the evolution of the medical center that I believe, in retrospect, were absolutely crucial to propelling it forward. The first was the decision of Jewish Hospital to move its new building to this campus in the late 1960s.

The concept of being close to the medical school (then located in what is now the Jefferson County Medical Society building) was farsighted. Despite some missteps along the way, Jewish Hospital has become a progressively staunch ally of the School of Medicine.

The second was the sleight of hand involved in achieving matching funds for (then) city-owned UofL to build a Health Sciences Center. Though it preceded my time here, out of thin air there crystallized a creditable Health Sciences Center around the quadrangle that has served the university and community extraordinarily well in the past 30 years.

The third event was the shift of the respected Norton Hospital to the health sciences campus, along with Children's, and its subsequent liaison with Kosair Children's Hospital.

That kind and imaginative merger of venerable reputations has served the children of the Commonwealth extremely well.

Quality care

The fourth event, which should have been the most significant achievement of the 1980s, was Sen. Wendell Ford's decision to funnel much of the state's share of Nixon Administration revenue-sharing money into the establishment of a debt-free hospital for the University of Louisville.

Neither Norton nor Jewish, the university nor the Board of Health were alert to the possibilities that came with such a facility. Consequently, for more than a decade it was leased to the for-profit sector.

At the same time, Jefferson County's social experiment with Quality and Charity Care Trust to fund adult indigent in-patient care demonstrated that quality hospital care could be provided humanely and in an economically feasible way to thousands of uninsured citizens.

Combined with a more recent experiment in which the university was an active partner in Passport Medicaid managed care-provided to more than 100,000 beneficiaries-the community has learned much about efficient, effective health care delivery.

We also have learned that economic sense is not, on its face, at odds with the best quality medical and surgical care.

The role of research

Finally, the rebalancing of university priorities in medical education between teaching, compassionate clinical care and avant-garde research is extremely important.

One can easily argue that UofL and its students have benefitted from exceptional clinical experience and a common-sense kind of leadership. We have, at the same time, often been less than cutting-edge in sophisticated laboratory bench research.

It is both wise and proper that, with Gov. Paul Patton's help, the concept of matching endowments for top quality researchers has improved the environment in the medical school, even in the last 24 months, in a most positive way.

If I offer one caution, it is that we must not underrate the clinician teacher. We need to recognize and appreciate his or her special skills.

And we need to make certain that our new balance of priorities continues to reflect the unchanging mission of the medical school: to provide quality medical education, to take medical research to new frontiers, and to provide for our citizens the best available patient care.

Dr. Hiram C. Polk Jr. is chairman of the Department of Surgery at UofL's School of Medicine.