Dan Diamond, Managing Editor

Imagine a time before Medicare.

A time…

• When surgeons threw instruments with impunity—though you'd never see it on TV, because the American Medical Association approved all scripts.
• When nearly half of adult Americans smoked, but just one in nine were obese.
• When doctors might admit patients to a hospital as a personal favor to a family.

Essentially, you're imagining the early 1960s.

"And you have to understand—it was a simpler time," says E'Louise Ondash, who began her nursing career in 1964.

A look back
In many ways, health care's improved since those days. We've made dramatic strides in treating disease; the workforce has grown steadily more diverse; some bad personal habits, like smoking, have been drastically curtailed.

But Ondash and other older providers also lament what's been lost since the 1960s: Blissful ignorance of health costs. A sense of connection with patients.

In line with the award-winning TV drama "Mad Men"—which is set in the 1960s and returns on Sunday night—the Daily Briefing is offering a special two-day look, through interviews and data, on how health care's changed across the past five decades.

Click to expand the poster. (And then click the upper-right corner button to make it full-screen).

The shadow of the Vietnam War
One major difference between then and now: Young physicians in the 1960s had to contend with the possibility of military service, which changed the course of many careers.

In order to staff up the armed services' medical branch, the government had introduced a doctors' draft, better known as the "Berry Plan." The plan offered physicians flexibility as they finished their internships: proactively join the service of their choice and get full residency training in a specialty of their choice, too, or take their chances with the selective service draft.

But not all physicians chose the Berry Plan, or even had the option of taking it. Dr. Donald Trunkey had an extremely low draft number, which meant he faced a stark decision when finishing his internship at University of Oregon Medical School in 1964.

"I got a letter from the government offering two choices—join the army and become a captain, or get drafted and be a private," Trunkey told the Briefing. "It wasn't a hard choice!"

Trunkey ended up working in Germany, serving two years in a dispensary on army base. The relatively staid experience was a lesson for Trunkey: he didn't want to do primary care. Instead, Trunkey would go on to a long career in surgery at Oregon Health & Science University, where he remains today. 

But military service did offer some immediate perks. Trunkey's salary jumped from $125 per month as an intern to $2,500 per month as a captain. When he mustered out, Trunkey still received $300 per month from the government, which supplemented his salary as a resident at University of California-San Francisco.

Start of nursing's evolution
Some elements of nursing in the 1960s would be familiar today. There was a widespread nursing shortage, forcing new tactics for recruitment and retention. Nurse leaders were also beginning to develop a new theoretical base for nursing practice, Maryann Fralic told the Briefing.

(Fralic, a longtime adviser to the Nursing Executive Center, is in Boston this week to receive a lifetime achievement award from the American Organization of Nurse Executives.)

But the RN-MD relationship was staggeringly different. In the early 1960s, "nurses were treated as handmaidens of physicians," Ondash told the Briefing. "The [doctors] gave orders and nurses carried them out," with no questions.

Or to be more specific: nurses that had questions tended to keep quiet. With no formal avenues to report a physician's behavior, nurses who spoke up often faced reprisal.

For example, Ondash once expressed her concerns that a doctor was ordering too many interventions for a patient who was suffering terminal kidney failure, before the advent of dialysis. As a result of her comments, "that doctor laid into me...[and] I got in trouble," she said.

And who could Ondash go to for support? Not a nursing union—because she wasn't even aware of unions' existence yet.

• In tomorrow's issue: How care has changed since the 1960s, for better and worse.