Illness and accident are the interruptions to our life experience for which we cannot prepare. They are often sudden, though not always disabling,; but for many people their consequences are deeply traumatic. The availability of medical response services to those of us in the 'developed world' ameliorate the initial shock of the assault to our mortality to leave us to ponder our good fortune, as the doctors and their staffs reassuringly return their patient to a semblance of normality before carefully placing them on the steps back to good health. Centuries of practice have led to medical structures of great variance around the globe. "Trust me, I'm a doctor" might be a necessary command where time or resources are short, but where patients are knowledgeable and with personal resources for treatment, then the transaction changes to one of negotiation, particularly within a regulated hospital environment.

The author has been a practising physician for nearly half a century, writing several books on patient-centred medicine. ;His publisher was prompted to observed that he was surprised to learn that 'medicine had transformed from a cottage industry to a burgeoning enterprise in the course of only thirty years'.

Dr Hadler deftly steps through these years, noting the advances in clinical practice, backed by scientific approaches to research as pursued within notable institutions and schools of medicine. Serving as a physician requires a concerted and ongoing attempt to define the limits of certainty, in a collaboration that recruits the patient, the community and the practitioner's peer group,; summaries of such collaborations going back to the 19th Century, traverse the socio-economic complexities of diagnosis and treatment in the United States, the development of organised medicine and the establishment of medical schools across the huge country. Discussion of the coming of Medicare prompts reference to the European/Australian systems of socialised medicine and the 'cold war' battles between doctors and governments over wages and conditions, which like any industrial relations dispute, in the case of Britain, was eventually settled, though now emergent again. Standing away from such approaches, the good doctor nonetheless raises the alarm over the tendency for the teaching and research hospitals in the USA to engage external contracted research organisations, which invariably have cosy relationships with pharmaceutical and equipment manufacturers, arrangements which thereby widen the gap between patient and physician as corporate objectives confuse data useful to the practitioner and thus the patient.

This volume will be essential reading for med school students and invaluable for high school graduates considering medicine and doctoring as an occupation or a vocation, with the humanist expectations of either, laid out here for consideration and rumination.

For other researchers, insights into a profession and an industry so central to ourselves, our fellows, and our community, might encourage reflection on the social context for non-medical research projects being pursued with funding support from funders who may have agendas at a tangent to planned outcomes.

A glossary of titles used in hospital hierarchies would have been helpful in escaping presumptions made in television melodramas as to roles and responsibilities of dramatis personae.