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American Bar Association




As recently as the turn of the century a random patient meeting a random physician had less than a 50:50 chance of benefiting from the encounter. Physicians were just beginning to emerge from the era when they were essentially tradesmen, often with little more to offer their patients than comfort and company during illness and death. The principal causes of mortality were the infectious diseases against which the medical community stood impotent. There were few medical schools, few diagnostic tests, no specific treatment of disease, and no specialization of physicians. In the words of former AMA president Dwight L. Wilbur, "It is difficult to accept that physicians of that day and this were even in the same profession."1

Medical progress during the past century has brought about a radical change in the doctor's ability to diagnose and treat disease. Infectious disease has all but been conquered and the chronic diseases, such as heart disease, have become the major killers. Hospitals have replaced "pest houses." Medical education has become increasingly demanding and exact. While the technology of medicine no longer resembles that of a century ago, physicians continue to argue that in many other respects the practice of medicine cannot and should not change. The commonest form of this argument is that the "traditional doctor-patient relationship" must be maintained at all costs. In view of the tremendous changes in the content and context of that relationship over the past century, this argument would seem to be of dubious merit. The advantages of maintaining such a "traditional" relationship in theory if not in actual practice are many, however. Accountability for actions is likely to be restricted to Medical Advances, 67 ANN. peer review. Public scrutiny of medical decisionmaking is likely to be minimal. Autonomy of action is likely to be maximal. Patient-consumer influence on services rendered is not likely to be significant.

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