Although the relationship between patients and doctors is often idealized in terms of universal and timeless principles, it has not been immune from the larger social and cultural forces surrounding it.

This relationship has been profoundly shaped by the human rights movement of the past several decades, and clinical care today is guided by norms of shared decision making rather than benevolent paternalism.

Clinical research is no longer regarded as a side benefit of providing patients with clinical care, but rather as a compatible but distinct activity that requires us to view patients as partners in the process of advancing medical knowledge.

And finally, the greatest challenge still lies largely before us, as we will struggle in the years to come to balance the personal advocacy that all patients rightfully expect from their physicians with the equally compelling obligation of physicians to see that health care resources are used wisely in ways that are efficient and fair