In medicine, all of us tend to operate in a continuum of sorts, in the respect that we can visit one another's medical centers and find structures and forms in patient care, in teaching, in investigative activities, and in administrative arrangements that are quite familiar. We can move about the country and find that clinical problems are approached similarly almost everywhere and that our troubles in teaching, in learning, and in trying to be good physicians are much the same, too. In fact, one of the really attractive things to me about physicians is that we tend to worry about the same things. I find that reassuring.
But great shifts and fluxes are operative now in American medicine that seem to me to be important. I would like to explore some of these changes in this paper. In particular, I want to consider the general thesis that the central and
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