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Arch Dermatol. 1998;134:1151-1152.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

IT SEEMS too natural to me to suggest that medicine is rapidly changing. I went to medical school in the early 1980s and was impressed by the rapid progress in our supposed understanding of disease mechanisms. These advances were primarily advances in "wet lab [laboratory]" sciences, such as immunology and molecular biology. In the 1990s there has been a swift movement toward unlocking the genetic mechanism of disease. Therapeutically, there have even been attempts at altering the genetic makeup of an individual or their cells to cure or alter the progression of a disease. Yet, it seems to me as a clinician that no change has been as dramatic as the changing landscape of who is primarily responsible for patient care and who pays the bill.

When I began medical school it seemed to me that either the physician or patient determined who should care for a patient's ailment. Today . . . [Full Text of this Article]

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