The health care system has changed a lot since 1967, when D.C. Health Commissioner Andrew McBride, then a medical student at the University of Pennsylvania, wrote an article in a school newspaper titled, "The Bedside Manner -- Or How to Pretend That You Like the Niggers on the Ward."

"It made a splash, I can tell you that," recalled McBride.

He said the article was intended to jolt his colleagues out of habits that tended to reinforce "the really flagrant dual-class sys- tem in hospitals" at the time. In many hos- pitals, crowded wards were filled mainly with poor black patients, while private and semiprivate rooms were reserved for whites.

Doctors also were encouraged to use different language in speaking to poor black patients, McBride said.

"You never told them it was syphilis," he said. "You told them they had 'bad blood.' You never told them they had sickle cell disease. You called it 'sick cell disease.' "

Such language merely "continued to mis- educate people," McBride said. Although the most flagrant aspects of the two-class hospital system have been abolished, McBride said, other problems persist. A continuing shortage of black doctors and black managers exists in most health care institutions, and a recent report by the Department of Health and Human Services documents the most basic gap of all -- higher rates of illness and death from major diseases in black Americans.

"I don't think it was enough," McBride said, "to say a change in life style is necessary."