Reflections and Conclusions

Abstract

In effect, this is an "adventure book." True, it is technical, offering the distillate of years of experience and accumulated wisdom from roughly 20 medical experts, mainly physicians. The terrain is that of multiple medical specializations, including the entities constituting primary care, family medicine, and internal medicine. Each is a delimited world enveloping a defined group of physicians. For example, the environment of pediatrics is vastly different from that of pain medicine, even when there is some overlap. The common factor for both, however, is, of course, people – the sick and otherwise compromised patients who we treat. The other main commonality is the importance we as treaters have to our patients, not so different from the leader of a climbing expedition who is responsible for each climber. In that case, your welfare and perhaps your life is in the leader’s hands. If you have ever been seriously ill or hospitalized and fully dependent on medical providers, you know what we mean. Drs. Graf and Intinarelli (Chap. 24) make this point clearly when they emphasize the central importance of the “therapeutic relationship” to medical outcome, its palliative and curative value having been repeatedly confirmed in the medical literature. Of interest is our observation that the ideal location for treating complex cases is likely to be in the community, since it is there that a treatment relationship is most likely to be developed and sustained [1–3].