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Paper #3


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Paper #3

  1. 1. Lackey 1 Candace Lackey Professor Faaleava Professions 12 November 2002 Where Did Cardiologists Come From? Throughout the twentieth century American cardiology has developed into an extremely powerful and dominant profession within the medical field. The essay “Hearts and Minds: The Transformation of American Cardiology,” Joel D. Howell, explains how this transition flourished into its current condition. Though Howell chose not to use a traditional or historical context to discuss the transformation of American cardiology, his perspective interestingly portrays how social interventions influenced American cardiology throughout the twentieth century. In addition, Howell identifies how the definition of cardiology has also changed over time. Howell also clarifies how internists carried cardiology to the forefront of the medical profession, through the ever-changing epidemiology of cardiology and the predominance of cardiac disease. These prolonged strands of medical advances and social influences concerning cardiology and cardiologists molded the current structure of twentieth century cardiology. By looking beyond the historical facts of American cardiology, Howell finds that current American cardiology is a reflection of the influences made by the American society and American physicians (265). His careful analysis examines how, “American’s, primarily physicians, have conceptualized the specialty of cardiology during the twentieth century” (243). The relationships between American society, groups, and organizations transformed the meaning of American cardiology, “The
  2. 2. Lackey 2 definition of cardiology changed from public health to physiology” (243-244). Groups including: Progressive public health movements, the American Board of Internal Medicine, the American Heart Association, and the American College of Cardiology guided this transition (266). Meanwhile, the advent of the electrocardiogram coupled with the success of the public health movement against tuberculosis, refocused the attention of American cardiologists into specialties and subspecialties (265). Clearly, this transition did not take place in isolation. Encouraged by the prevalence of cardiac disease and the constantly changing epidemiology of cardiology, physicians became specialized and gained a commanding position within the medical profession (266). The driving force responsible for cardiologists’ newfound market share was the relationship between cardiology and internal medicine. “Cardiac disease is common, and diseases classified as those of the circulatory system are the most common reason for visits to general internists” thus, “Cardiology became formally established as a subspecialty of internal medicine in 1940, when the newly formed American Board of Internal Medicine (ABMI) voted to certify internists as subspecialties in four areas: allergy, gastroenterology, pulmonary disease, and cardiovascular disease” (250, 264). Rather than seeing a general internist, patients in need of specialized cardiac care went directly to cardiologists. Today, as a subspecialty, cardiology owns the market share within the medical profession due to the influence of and associations between internal medicine and cardiology. American cardiology in the twentieth century was redefined by many historical and social influences. Mediated by the relationships of many groups and organizations, the definition of cardiology changed its focus from public health care to a more technical
  3. 3. Lackey 3 and physiological orientation (265). However, without the strong relationship between internal medicine and cardiology, cardiologists today may not be in the forefront of the medical profession. Therefore, through the redefining of cardiology, cardiologists fulfilled the market demand for specialized physicians. As a result, today American citizens demand only to be treated by specialized physicians.
  4. 4. Lackey 4 Works Cited Howell, Joel D. “Hearts and Minds: The Transformation of American Cardiology.” Grand Rounds: One Hundred Years of Internal Medicine. Maulitz RC, Long DE, eds. Philadelphia: University of Pennsylvania Press, 1988: 243-275.