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December 1, 1978

Academic Family Medicine-Reply

Author Affiliations

Yale University School of Medicine Yale-New Haven Medical Center New Haven, Conn

JAMA. 1978;240(23):2540. doi:10.1001/jama.1978.03290230031012

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Dr Friedman's comments on my article are, as he promised, both practical and pertinent. They come, as I know personally, from many years of devotion to the teaching and practice of family medicine, and so are most welcome. Happily, too, Friedman supplements several points I had to make only indirectly for the sake of brevity.

Friedman's comments on the unfriendly environment of the university hospital are especially telling. This is a complaint heard all too frequently. It poses a serious and unmet challenge to those clinicians concerned about teaching the caring obligations of the physician. The legitimate needs of teaching and research unquestionably complicate the care of patients. But they cannot justify insensitivity in the place where nurses and physicians receive the first and often lasting impressions of how to care for those in need of their help.

Equally cogent are Friedman's observations about the unsatisfactory care of