1965-1974: ACP faces angry students, new specialists

ACP's sixth decade witnesses the founding of new specialties, new technological advances, and even a student protest.

Even in internal medicine, the times were a-changin’ in the late 1960s and early 1970s. The College dealt with the founding of new specialties, new technological advances, and even a student protest during these turbulent years.

Clinical medicine was changing, too. In 1965, the Board of Regents reviewed data on vaginal cytology and concluded that members should be educated about the benefits of this practice, although they “did not wish to promote the routine use of any one procedure in clinical medicine as College policy,” according to historian and former College Executive Vice President Edward C. Rosenow Jr., MD, MACP. (Just a few years later, College leaders would revise their position on guidelines, proposing a new project in which a few experts “would define criteria for acceptable medical management of a specific group of diseases.”)

The medical perspective on smoking was also evolving, with Regents recommending internists inform their patients about the dangers of smoking in 1965 and banning smoking at all College meetings in 1969.

There was some smoke at College headquarters in 1966, when a fire, started by a defective air conditioner, destroyed a portion of the building, including all of the advertising records for Annals of Internal Medicine (but luckily, only 2 manuscripts). Repairs and upgrades were completed in 1971.

The College also updated the Fellowship Pledge. After 1966, new Fellows no longer had to promise “I will avoid commercialism in all my professional activities. I will refrain from seeking the public eye for purposes of seeking self-advancement and I will ask fees commensurate with my services and adjust to the circumstances of the patient.”

That change was not what drew the Students for a Democratic Society to the 1971 Annual Session, however. They came to protest the research of one of the meeting's speakers. About 300 students caused “noisy pandemonium” during the general session, and a young man who tried to vault onto the stage was hauled off by police. But it all ended civilly, with the addition of an afternoon session in which the students asked “some very intelligent questions,” Dr. Rosenow noted.

ACP faced conflict within medicine, too, in the continuing struggle over the roles of the College and the American Society of Internal Medicine. “The difference in age and maturity of our respective leadership hasn't helped smooth out differences,” Dr. Rosenow reported saying at a Regents meeting in the late 1960s. Perhaps not surprisingly, plans to merge did not come to fruition at the time.

Two new specialties also formed during the decade. First were the family practice physicians, whom College leaders weren't sure should be a specialty, noting “the need for prestige for this ‘new physician’ by the formation of an American Board of Family Practice was not demonstrated.” They eventually came around and offered to provide advice on residency training.

The need for emergency medicine specialists was more apparent, with College leaders noting in 1971 that the field “currently was filled with physicians who enjoyed working in emergency medicine but might not be particularly well qualified.” Dr. Rosenow specifically commented that “We can communicate with astronauts in space, but can't get a communication system operating so an ambulance can be in voice contact with the emergency room it is approaching.”

In other aspects, medical technology was advancing rapidly. Attendees at the 1969 annual meeting learned about computers in medicine, watching a computer in action at Massachusetts General Hospital that allegedly featured “automated medical history taking, recording and retrieving information, a computer-aided plan for treating patients, a method for making diagnoses based on sequential decision-making, and many other features.”

ACP wasn't computerized yet, but in 1967, the College launched “a voluntary educational program designed to provide members with an opportunity for self-evaluation of their current factual knowledge of internal medicine.” Shortly after, the College bookkeeper categorized an expense as part of the “medical knowledge self-assessment program” and thus, MKSAP was born and named.

To educate the public, the College produced a movie, “Portrait of an Internist,” depicting the typical activities of an internist. A Fellow of the College who happened to have “good acting ability” starred in the film, which Dr. Rosenow noted was “made available for presentations at College meetings and to the general public via television and screenings to clubs,” attracting more than 5 million views in the 2 years after its 1965 release.

Based on this success, College leaders planned additional films for patients, teaching self-care techniques, general physiology, and some specific disease information. However, Dr. Rosenow noted, “the College had to be very careful to avoid information that some physicians might not wish their patients to have.” Little did they know what Google would bring.