On that particular day, the entering students, all one hundred of us, were taken as a group to the local Veterans Administration hospital. We marched proudly into the auditorium, sat down in hushed anticipation, and the dean of students said, "We are going to bring in your first patient." An elderly man in a bathrobe was led to the center of the stage. Addressing us, the dean said, "Tell me what disease this man has."

There was a second of silence, and then our questions started popping. We wanted to know if the man had a pain here, a pain there. The man answered all kinds of questions as best he could. He was direct and succinct; he must have had some experience with such demonstrations. After fifteen minutes one of the students made the diagnosis: "He has an ulcer."

The dean nodded with pride. "Yes, he does.... That is wonderful! See how good you already are as physicians, and you have not even gone through medical school."

So here was the first lesson I learned as a doctor-to-be: ask for symptoms, make a diagnosis, and treat the symptoms. From those first moments in medical school I learned to focus on disease rather than health, pathology rather than the person, parts rather than the whole, an ulcer rather than an ulcerated life.

During the next four years, we learned to perfect our skills in this area: to take a medical history, perform examinations, differentiate among a constellation of symptoms, and, of course, treat the disease or ailment. When we graduated, we were the products of an expensive, thorough, and excellent education in the treatment of disease. We had an ever-expanding technical arsenal and a knowledge of hundreds of drugs to help us treat the sick.

We traveled across the country to internships and residencies. Finally, the day came; our training was complete, and we began to practice medicine. In private practice, at a university, or in a health plan, we were ready for our first patients.

The Patient Gets Trained, Too
As a consumer of medical care, you receive training, too. You have learned that, if you are troubled or ill and in need of diagnosis and treatment, you must first check your health insurance card and then call your health plan or physician's of lice an appointment. The physician you call will likely be a primary-care physician or a specialist limiting his or her practice to a specific anatomical area: foot, nears, bone, etc. Your ticket of admission is a symptom, preferably a physical symptom. Those symptoms that receive the most urgent attention involve blood, pain, or a lump. You leave for your appointment with a mixture of apprehension, expectation, and relief. The office, more than likely in a nondescript sterile building furnished with generic tables, chairs, and outdated magazines, is watched over by the office staff, who are well separated from you by an impenetrable glass wall.

When your turn arrives, you enter the doctor's consultation room, nervously find your chair and take note of the diplomas and licensure conspicuously placed on the wall. Each testifies to the training and professional status of the physician, assuring you that the physician is scientifically trained, tested, and certified.