JAMA. 1968;203(12):1062-1063. doi:10.1001/jama.1968.03140120060016.
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It has long been the prerogative of the elderly to mourn the passing of the old days and ways. The accelerating changes of the past decade have provided persons so disposed with a plethora of occasions for this kind of sorrowing. Older and even middle-aged physicians, while acknowledging and utilizing the phenomenal scientific advances of the period, have their own reasons for sadness. Among them is the erosion of one of the traditional principles of medical practice: that the attention given the patient by his doctor should be direct and personal. This precept is disintegrating under a number of identifiable pressures, some perhaps reducible, others probably not, and none easily.

The heaviest pressure is that of time. The shrinking supply of that commodity, so far as the doctor is concerned, is owing to a number of factors: one is his enlarging patient load, resulting (to labor a familiar point) from


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