Twenty-five years have passed since I wrote Five Patients. When I reread the book recently, I was struck by how much in medicine has changed-and also, by how much has not changed. Eventually I decided not to revise the text, but to let it stand as a statement of what medical practice was like in the late 1960s, and how issues in health care were perceived at that time.

By design, the book is highly selective, and some of the most dramatic social changes in medicine were not anticipated in its discussions. This book was written before the great government interventions of Medicare and Medicaid; before the onslaught of malpractice litigation, which transformed medical practice; before the rise of group practices and HMOs; and before the entry of large numbers of women into the profession as physicians. At the time this book was written, abortion was illegal; patient rights were barely discussed; the right to die was only beginning to emerge as an issue for the future; and genetic testing was still an exotic, experimental procedure.

At the same time, the description in Five Patients of life in the emergency room seems little different from the present day; the training of new doctors is largely unchanged; the influence of medical history on present attitudes remains as important now as it was then; and the struggle to master new technologies, and to mount new surgical techniques, seems entirely contemporary.

Much of the book focuses on emerging technologies, and it is interesting to see how cutting-edge technologies in the 1960s have fulfilled, or failed to fulfill, their promises. The use of closed-circuit television for "remote doctoring" has not found wide application, but some observers think that this is because the technology is still emerging, and will reach fruition when a combination of robotics and virtual reality allow surgery to be performed by a surgeon thousands of miles away.