I served as the chancellor for health affairs of Duke University
from January 1989 ­ until the end of my third five-­year term on
June  30, 2004. When I started, I had hoped to enhance the stat-
ure of an excellent medical school and university hospital. By the
time I stepped down, we had accomplished this and much more.
By 2004, the Duke University Medical Center and Duke Univer-
sity Health System represented a paradigm shift, having replaced
one concept of an academic medical center envisioned a ­ century
earlier with something dramatically dif­f er­ent. Duke created a vast,
integrated health care delivery system, stood among the nation’s
largest academic biomedical research enterprises, and could claim
a leading school of medicine, an innovative and growing gradu­
ate school of nursing, a satellite international school of medicine
in Singapore, and a novel orga­nizational structure to oversee the ­
whole, multifaceted enterprise.
More impor­tant than institutional markers of pro­gress, how-
ever, is that engagement in ­these diverse health-­related activities
enabled the creation of new models of health care delivery itself.
Moving beyond the disease-­oriented approach, Duke led the
conceptualization and implementation of integrative medicine by
focusing on the holistic needs of patients and engaging them actively
in their own care. Then, from the merger of new science, advanced
Introduction
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