Medical education: a continuum in disarray.

I have addressed the issue of medical education from the standpoint of a person who has been actively involved in the field for more than 30 years. The enthusiasm for technologic advancements and the emphasis on a regulated life with adequate creature comforts has made the teaching of the basics of good medicine, that is, listening carefully to the patient and examining carefully all of the patient, at best, a secondary effort. This has been enhanced by the emphasis in medical schools on research and the results of research, publications which are more often than not counted or weighed rather than read. Suggestions for change include (1) putting the patient first in the health care equation; (2) rewarding teaching and clinical care equally with research; (3) placing real clinicians on medical school faculties; and (4) establishing a national health service in which all medical school graduates must serve in physician-sparse areas for a period of time after graduation, preferably without a single computerized tomography scanner, magnetic resonance imaging unit, or advanced radiologic imaging device within reach.