CCHS

A Special Kind of Doctor: A History of the College of Community Health Sciences. By Patricia J. West with Wilmer J. Coggins. Tuscaloosa: College of Community Health Sciences of The University of Alabama, 2004. xviii, 178 pp. $27.50. ISBN 0-8173-1429-6.

The United States is currently experiencing a crisis in the healthcare industry-marked by millions of uninsured people, skyrocketing costs, and ongoing debates over preventative care, access, and cost controls. Historical and policy-oriented scholarship can do much to connect this crisis to broader themes in American culture and account for the dysfunctional system it has produced. In A Special Kind of Doctor, science writer Patricia J. West and Wilmer J. Coggins, M.D., former dean of the University of Alabama's (UA) College of Community Health Sciences (CCHS), present a laudable institutional history of CCHS and its connections with the national healthcare crisis.

The authors examine the development of CCHS within the context of what they consider to be the preeminent healthcare policy question for Alabama, and presumably for the nation-whether medical education and healthcare policy development should adopt a research and technology-driven perspective or whether it should be more interdisciplinary in orientation and also consider economic, social, and other cultural factors. The critical need in Alabama, with its many rural and poor counties, was to encourage new physicians to become family practitioners, and to convince them to practice in rural Alabama. CCHS would become the means for meeting that need.

Established by the Alabama legislature in 1972, CCHS was founded on a philosophy of community-based medical education. This entailed, among other things, a focus on family practice with emphases on rural and community health; outreach programs, such as a clinic for minorities in Tuscaloosa; and instruction by private-practice physicians. This philosophy, faithfully pursued by CCHS's first dean, William R. Willard, M.D., created ongoing tensions with the main campus of UA's School of Medicine (UASOM) in Birmingham and its dean, James A. Pittmanjr., M.D. According to West and Coggins, Pittman was an adherent of the reductionist, technology-driven approach to healthcare education and policy, and he believed Willard's philosophy was "too centered in public health and preventive medicine" (p. 56).

Indeed, Pittman's clash with Willard caused severe problems for CCHS, especially regarding the accreditation of UASOM, as Pittman's views held sway during the repeated reviews by the Liaison Committee on Medical Education (LCME) throughout the 1970s and into the 1980s. In 1980 Willard retired, and UASOM reorganized after a scathingly negative review. Pittman prevailed, and by 1981 he had financial and administrative control over both the Tuscaloosa and the Huntsville campuses.

Author Coggins, who took over the deanship in 1981, stands as the savior of CCHS after Willard's departure, but this is not to say that Coggins exaggerates his role. If anything, Coggins could have provided more personal detail on his clashes with Pittman and more insight into why Pittman did not want him to be "another Willard" (p. 74). After initially scaling back outreach, Coggins successfully implemented the community-based philosophy of CCHS. By the end of his tenure, with CCHS effectively holding its own financially, it became possible to approve an interim dean with a Ph.D. in medical sociology rather than an M.D. By the 1990s more emphasis was placed on community medicine, and CCHS even implemented programs in rural high schools in Alabama aimed at recruiting future rural physicians.

West and Coggins have provided a well-researched account of CCHS's role in the development and practice of community medicine in Alabama. While they do make some connections to the wider national debate over family practice and community health versus biomédical research-based medicine, more discussion along these lines would have been helpful. To what extent, for example, was CCHS a unique experiment? In addition, more analysis of the relationship between healthcare in Alabama and the cultural history of the state would have made the story of CCHS richer. In all, however, the volume is well written, engaging, and at times even suspenseful. It will appeal to historians, physicians, and all those concerned with our crisis in healthcare.

Michael W. Seltzer

Virginia Polytechnic Institute and State University

Copyright University of Alabama Press Jul 2005
Provided by ProQuest Information and Learning Company. All rights Reserved