the greatest exposure in the popular press, but these are not the only concerns warranting attention. Equally troubling is the manner in which medical care is delivered. Increasingly, physicians and other providers are perceived as lacking in compassion. Doctors are seen as coldly analytical and uncommunicative. Patients sense that physicians are losing the human touch and are more interested in their diseases than in them as people. Whether accurate or not, the Norman Rockwell image of the friendly, gentle, sympathetic, unhurried, communicative family physician of nostalgic memory remains powerful. Increasingly, today's medical care providers are perceived as having forgotten, or perhaps never having learned, the advice of older clinicians, expressed well by Francis Peabody of Harvard University long ago, that "the secret of the care of the patient is in caring for the patient" (Peabody 1927, 882).
In this article we attempt to reassert the fundamental importance of caring in the doctor-patient relationship and to suggest ways in which the administrative organization of medical services, including their financing, can promote or inhibit expressions of caring by physicians and other medical personnel. We begin with a brief statement about caring and why we believe it is fundamental to effective medical practice. This is followed by a discussion of certain features of the social organization and financing of modern medical care and their implications for the ability of care providers to deal with patients humanely. Throughout, we comment on the policy implications of our analysis.
Physician competence has three components: knowledge, skills, and caring. The first two are assumed and require no further elaboration. We believe that caring is as integral to medical competence as are knowledge and skills because caring fosters the bonds of trust that enable doctors and their patients to communicate. Effective communications are impo...