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The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care

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Sid Garfield's plan for health care reform was so far ahead of its time that the organization he founded -- Kaiser Permanente -- still drives toward the vision, years after his death. (Disclosure: I am senior director of communications and brand management for Kaiser Permanente's Colorado region).

This biography puts today's health care discussion into historical context. As early as the 1930s, reform proposals that threatened the status quo were called "socialized medicine." Garfield and uber-capitalist Henry Kaiser were "socialists" because they came up with a financing system that brought quality health care to working Americans. Workers and their employers "pre-paid" a few cents a day for full coverage. Garfield and his doctors and nurses were thus assured of a predictable revenue stream that enabled them to open clinics and hospitals close to work sites, such as the Grand Coulee Dam in Oregon, the California Aqueduct in the Mojavi Desert and the WW II shipyards in Oakland.

The financing mechanism also encouraged Garfield's team to reduce injuries and prevent illness. Workplace safety and the country's earliest screening and vaccination programs blossomed under the arrangement. The smoking cessation, stress reduction and nutrition classes offered by Kaiser Permanente today have their roots in this core emphasis on what Garfield called "Total Health."

Garfield's approach brought doctors of all specialties together under one roof. This "group practice" model is the environment in which doctors train, and it only made sense to continue it in day-to-day practice. Today, 60 percent of J.D. Power's top 20 health care systems are group practice models, such as Kaiser Permanente, Mayo and Harvard Pilgrim.

I was surprised to learn that Garfield created hospital designs. His put the medical team closer to patients and segregated sterile hallways from public ones. He installed pneumatic tubes so that "medical records will get to the doctor before the patient does."

Garfield championed computer-assisted medicine in the 1960s, recognizing that information is the currency of health care. With medical information collected and analyzed, doctors get granular about each patient's needs and they get the big picture about diseases and effectiveness of treatments.

Garfield's vision still unfolds today, as Kaiser Permanente recently completed an electronic medical records system that serves more than 8 million patients. But implementation of an EMR is only the first step toward Garfield's vision of a coordinated system of health care rather than sick care. In the next steps, patients use the online access to their records to become more engaged in their health care, physicians and their teams use the information to tailor care precisely to the patient need, and researchers compare the effectiveness of treatment protocols.

Ironically, Garfield, who believed his health care model would "keep medicine out of the hands of government bureaucrats," was called a socialist. President Obama, who has said the Kaiser Permanente model is one the nation should emulate, also is called a socialist. Perhaps we need to change the definition of socialist to: One who threatens the status quo.

Favorite Garfield quotes:

National health insurance, an attractive idea to many Americans, can only make things worse. Medicare and Medicaid -- equivalents of national health insurance for segments of our population -- have largely failed because the surge of demand they created only dramatized and exacerbated the inadequacies of the existing delivery system and its painful shortages of manpower and facilities.

It's really time for us to revitalize our plan. I suggest a radical new idea -- that we stop building hospitals and clinics for sick people. Let's concentrate on a brand new type of facility -- a new first in the world. Let us conceive a building for health -- designed, streamlined, and geared to serve our healthy members.

This change from episodic crisis sick care to programmed total health care forces a new look at the recording and processing of medical information ... Continuing total health care requires a continuing life record for each individual ... The content of that life record, now made possible by computer information technology, will chart the course to be taken by each individual for optimal health."

Note for Kindle users: There are lots of historic B&W photos sprinkled throughout. They show well on the Kindle.

I highly recommend this book for anyone interested in the early years of health care in the U.S. The book is a fascinating read -- vividly capturing who Sidney Garfield was and the overwhelming contribution he made to medicine. The chapters build Dr. Garfield's character through his early struggles of wanting to be an architect, through real-life accounts, writings, and photos of his growth in becoming a renowned physician. In Garfield's fortuitous encounter with industrialist Henry Kaiser -- to eventually becoming Henry's brother-in-law -- the book brings these men to life as magically as it tells the important history of early group medical practice in the U.S. A real page turner.

Tom Debley's book combines personal information about Dr. Sidney R. Garfield's life with his amazing professional career, which led to the founding with Henry Kaiser of the Kaiser Permanente Medical Care program. Numerous anecdotes and photos tell the story of how Dr. Garfield's vision of a health care program focused on wellness rather than sickness came to fruition - helped by prepayment, group practice, and the use of information technology. As a long-term employee of Kaiser Permanente, I was amazed to see how much of what Dr. Garfield advocated 60 years ago has influenced what's happening today.

Dr Garfield was the founding father of Kaiser Permanente physicians who developed
concepts of healthcare in the 1930s that are far sighted even today. His concepts of pre-paid group healthcare, with
an emphasis on healthy lifestyle and early diagnosis and of service to patients revolutionized healthcare. The book is well written life of a great healthcare pioneer.

The book was especially meaningful to me as I am a retired Kaiser Permanente physician

A great story about a visionary. Dr. Garfield started Kaiser Permanente and envisioned computerized medicine and preventive health as paramount in his system -- in 1960! The first Medical Center cared for the workers of the Kaiser Steel Mill, where workers paid 5 cents a week for medical care. A must read for health professionals, patients, and everyone in between! It is especially relavent as Kaiser has become a model for current healthcare systems.

I worked for Sidney Garfield as Mental Health Coordinator of the Total Health Care Program after I graduated from the Doctor of Mental Health Program at UCSF in 1980. I always felt that I was privileged to work with one of the true giants of American health care. I, too, believe that Dr Garfield has never received his due recognition in the field, so many thanks to the author for writing a book that highlights his numerous, groundbreaking contributions.

Dr Garfield was truly prescient. Over three decades ago, he anticipated, wrote about, and implemented many of the concepts that have become the buzzwords of the last decade --- "disease management," "demand management," and "primary care reengineering," for example. He also pioneered population management, health risk appraisal, automated medical records, consumer empowerment and the integration of health education and behavioral health care into the primary care setting to meet the needs of the "well" and the "worried well." Unlike most physicians, he approached the primary care and hospital delivery systems with a productions, operations, and management vision that is very atypical in medical settings. As well as describing his unique contributions to American healthcare, The Story of Sidney Garfield gives fascinating insights into the man's social development and life experiences. The personal attributes of this gracious, generous and unassuming man come through loud and clear. Working with the septuagenarian Dr Garfield as a 28-year-old definitely gave me the feeling that I was developing in the shadow of greatness.

In closing, Dr Garfield was a true innovator. Working closely with him in the early 80's was a unique and valuable experience: more than anyone else he has inspired my professional life in subsequent decades. Thank you, thank you and thank you to the author of The Story of Sidney Garfield for honoring him so well.