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Doctoring: The Nature of Primary Care

Donald L. Madison, MD
JAMA. 1997;278(19):1628-1629. doi:10.1001/jama.1997.03550190098059.
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Eric Cassell's name is well known to the students at my medical school, who early in their first year read—to good effect—a portion of The Nature of Suffering. His earlier book, The Healer's Art, and the more recent Talking With Patients have also enjoyed appreciative audiences; and so the appearance of a new Cassell book is of more than passing interest.

The title Doctoring calls on a term that carries several different meanings. Lord Dawson of Penn first used "primary" care to advance the concept of the health center, an institution he believed should form the base of an idealized, hierarchical medical care system for post-World War I Britain. Dawson's scheme was never implemented, but his original, organizational use of "primary care" reappeared several times after 1920. It was not until the 1960s, after the general practitioner (in the United States) had been minimized, that the term took on


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