DO WE STILL NEED DOCTORS?

The title's challenging question is only one of the many posed in this wide-ranging examination of doctors and the practice of medicine. Lantos, a physician who describes himself as a professional moralist, is asking how recent developments in the delivery of health care change ``what we should think about the proper response to illness and suffering, how we should train the people whom we empower to respond, and how we should shape the institutions that educate those people and deliver those services.'' To explore these questions, Lantos, a bioethicist at the University of Chicago and pediatrician in a hospital for chronically ill children, tells troubling stories from his own experiences. The role of doctors, says Lantos, has always been partly interventionist (diagnosing and treating) and partly interpretive (understanding and explaining the meaning of illness). The interventionist model, he asserts, has won out. The essence of modern medical practice is alienation, disengagement, and ``a weird equanimity in the face of horrific disease.'' Yet while we insist on the physician as scientist, we still yearn in our hearts for the old humanistic model of physician as shaman/healer. Lantos questions whether a single profession can contain these contradictory notions. We may, he says, be witnessing the creation of a new profession ``driven by science, technology, reductionist ethics, and entitlement economics.'' He is not optimistic about the future of medicine, questioning whether some core of morality or belief will persist underneath the transformations that are taking place. Fiction provides some of the most imaginative responses to the question of what we want doctors to be and do, says Lantos, and he concludes by turning to authors Robertson Davies and Walker Percy, among others, for visions of the challenges facing doctors. A disturbing, often painful examination of a profession in transition. (Author tour)