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Perspective: Prospective Health Care and the Role of Academic Medicine: Lead, Follow, or Get Out of the Way

Snyderman, Ralph MD; Yoediono, Ziggy MD, MBA

Academic Medicine:
doi: 10.1097/ACM.0b013e31817ec800
Health Care Reform

The authors contend that the crisis facing the U.S. health care system is in large part a consequence of that system's disease-oriented, reactive, and sporadic approach to care, and they suggest that a prospective approach to health care, which emphasizes personalized medicine and strategic health planning, would be a more rational way to prevent disease and maximize health. During recent years, personalized, predictive, preventive, and participatory medicine—that is, prospective care—has been receiving increasing attention as a solution to the U.S. health care crisis. Advocacy has been mainly from industry, government, large employers, and private insurers. However, academic medicine, as a whole, has not played a leading role in this movement. The authors believe that academic medicine has the opportunity and responsibility to play a far greater role in the conception and development of better models to deliver health care. In doing so, it could lead the transformation of today's dysfunctional system of medical care to that of a prospective approach that emphasizes personalization, prediction, prevention, and patient participation. Absent contributing to improving how care is delivered, academic medicine's leadership in our nation's health will be bypassed.

Author Information

Dr. Snyderman is chancellor emeritus, Duke University, Durham, North Carolina; and James B. Duke Professor of Medicine and director, Duke Center for Research on Prospective Health Care, Duke University Medical Center, Durham, North Carolina.

Dr. Yoediono is senior research fellow, Duke Center for Research on Prospective Health Care, Duke University Medical Center, Durham, North Carolina.

Correspondence should be addressed to Dr. Snyderman, Office of the Chancellor Emeritus, DUMC 3059, Durham, NC 27710; telephone: (919) 684-6637; fax: (919) 681-9977; e-mail: (

Editor's Note: Commentaries on this article appear on pages 705 and 706 of this issue.

© 2008 Association of American Medical Colleges