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Introduction

Imagine the practice of medicine a hundred years ago: a time before antibiotics, complicated imaging, and the advent of miracle drugs that cure disease or at least significantly alter its course. There’s a picture I use in presentations of a solo practitioner walking through a farmyard carrying the iconic black medical bag. Most of the medical miracles of a hundred years ago were contained in that black bag, but most of the healing that doctors did rested in the hands that carried the bag and the relationships and interactions that the physician had with patients and families.

As the leading early-twentieth-century physician, researcher, teacher, and humanitarian Francis Weld Peabody observed to a group of Harvard University medical students in 1927, “The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond.”1 Physicians and nurses of that day would deliver whatever medicine they had and dispense whatever care they could, but for the most part, they were providing comfort and compassion. They talked with patients and families, and they touched people, giving them reassurance and hope when there may have been little.

When I consider how we deliver medicine today, I think of my operating room or an intensive care unit. Both are filled with teams of highly trained professionals working with the best medical technology on the planet: the practice of medicine has evolved from an individual pursuit to a team sport. When I was an intern, patients who had an inguinal hernia repair often stayed overnight in the hospital. Today they spend a few hours in the postanesthesia care unit. Inpatients today are older and sicker and have multiple medical problems. We often note that large tertiary-care hospitals around the country are becoming gargantuan intensive care units.

Patients First as Founding Principle

Cleveland Clinic was founded close to a hundred years ago, when four solo practitioners with their black bags determined to form a unit to care for patients. Beginning with its unique group practice model in 1921, the organization differentiated itself on innovation, one of the key drivers of Cleveland Clinic’s success today. Coronary angiography was invented here in 1958, and it revolutionized the treatment of heart disease. This was soon followed by the first cardiac bypass surgery in 1967. These and other innovations helped Cleveland Clinic grow in size and renown, bringing patients from all over the world and driving a high volume of procedures that further enhanced its reputation as a clinical and academic powerhouse. Today, 14 medical and surgical specialties rank in the top 1, and the hospital overall is ranked number four in the country according to U.S. News & World Report. The organization’s focus on clinical excellence and its unique model of medicine have brought it to ...

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