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I Have a Concern for Thee

William Y. Rial, MD
JAMA. 1982;248(9):1069-1070. doi:10.1001/jama.1982.03330090039024.
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That part of Pennsylvania where I live and work happens to be Quaker country. Although I'm not of that religious persuasion myself, I am occasionally addressed as follows:

"William Rial, I have a concern for thee."

It is a Quaker habit to discuss such concerns not in a dictatorial or disciplinary way, but in terms of what they call "friendly persuasion."

From within that context, I'm going to discuss a concern I have for thee; for each of you and for our friends and colleagues; for this wonderful profession of ours; and for the patients that we serve.

My concern does not center on the art or the science of the medicine that we practice. The quality of these has never been better.

A century ago, in seeking the best in medicine, some Americans went to Vienna, to Paris, to London, to Edinburgh, or to other European medical centers. Today


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