July 18, 1986

The White Coat

Author Affiliations

East Stroudsburg, Pa

JAMA. 1986;256(3):345. doi:10.1001/jama.1986.03380030047010

The practice of medicine has changed so much since I opened my door that I wonder what my role is as a practitioner. During my early career, there was no state and federal mechanism to compensate for the dispensing of medical services. The provision of medical care to the indigent was the collective responsibility of the medical community and was dispensed through free clinics that we manned on a rotational basis without charge. Most of the hospitals were publicly owned; annual charity functions provided sufficient funds to pay for in-hospital care. The system worked and worked well. Most important, we were DOCTORS, not health care providers. Our profession was respected, our colleagues assisted without hesitation, and most of us enjoyed our work. The income derived from services rendered was secondary; the service provided was primary. Fees were adjusted by the ability to pay and by the difficulty of the procedure.