There have been great advances in medical and scientific knowledge in the ensuing century, and there have been myriad changes in health care in the past 20 years. Not all the changes are viewed necessarily as being effective, but as society is faced with the necessity of making changes that would allow health care to remain accessible to most of the nation's people, rather than watching it evolve to a luxury only for the most wealthy of our citizens. Accompanying policies also have not met with great favor, and many, such as nursing shortages and high prescription costs carry more than only medical implications.
             George Whitsell (1999) asks, "Who is there that has not, either personally or on behalf of family or friends, had to confront the indifference, the exorbitant cost, the mind-boggling complexity, and sometimes even the malevolence and authoritarianism of modern medicine?" (p. 52). It has been little more than a century since all doctors were surgeons, and aptly referred to as "Sawbones." They did little else, and they also did not enjoy the great respect and social standing so common today.
             Paul Starr's (1983) book, "The Social Transformation of American Medicine," provides insightful vision into the changes that had occurred until the time of its publication, but the book was published before the latest wrenching changes in health care occurred. Background included in Starr's (1983) work is useful in analyzing some of the changes in today's health care organization, in that he traces reasons for changes in perceptions of the medical community. He notes that doctors were little more than practitioners of some mystical applications involving items and procedures generally seen as suspect, and that the American people have evolved from a place where they gave the medical profession little consideration to that in which they cling to every pontification of their personal MDs.
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