rationing of the surplus.”
One other factor pertaining to the future is the public’s view of
physicians. Recent polls have indicated a dramatic change for the
worse in public opinion regarding medical care costs and physician’s
fees, their reasonableness, and doctors’ interest in making money.17
We thus have to ask ourselves: “What is our role?” As the greatest of
Kentuckians, Abe Lincoln, said, “As our case is new, we must think
and act anew, we must disenthrall ourselves.”
I think we can disenthrall ourselves and conclude that medical
delivery systems come and go but the profession remains. The
playwright and philosopher Seneca said 20 centuries ago: “Why
is it that I owe something more to my physician and teacher, and
yet do not complete the payment off what is due to them? Because
from being physician and teacher, they become friends, and we are
under the obligation to them, not because of their skill, which they
sell, but because of their kind and friendly goodwill.”18
In the Landmarks in Medicine series completed in 1984 in the
Journal of the American Medical Association, the final article was
Dr. Francis Peabody’s “The Care of the Patient.”19 That illustrious
man told us shortly before his premature death: “The secret of the
care of the patient is in caring for the patient.”
In the short run we will be tested in the maintenance of our
professionalism. If we remember that the word “profession” has a
religious significance rooted in the 13th century use of the word as
a vow, then developed into an order of professional persons, we can
maintain our special character in society and our collegial spirit in
a competitive mode again.20
It is clear to me that our role will be to carefully evaluate systems
of care as we participate in them. We will need to be certain that we
can maintain our relationship in the care of the patient. As a few of
you know, I have a special affection for the Lancet. Even this week
there is an article dealing with the peculiar problems of the poor in
new systems. It is up to us to decide whether the system is at fault,
or is it us in the system?
In conclusion, there is no way to judge our destination. It depends
on all of us and particularly on you.
That’s why I will close with an inscription I saw in a window of
the Salisbury Cathedral, dedicated to Royal Air Force glider pilots,
a group particularly analogous to us:
4) Flexner, A.: Medical Education in the United States and Cama-
da. New York: The Carnegie Foundation for the Advancement
of Teaching, No. 4. 1910.
5) Committee on the Cost of Medical Care, Medical Care for the
American People. Chicago: University of Chicago Press. 1932.
6) Altman, S. Personal Communications