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In 1946, Dr. Grete L. Bibring presented a series of formal lectures to the students at Harvard Medical School. They were followed by discussion periods, combined with teaching rounds on hospital
wards, where the patients were interviewed. Their aim was to develop, with the help of clinical material and the theoretical framework of psychoanalytic psychology, a program of comprehensive medicine.
At the present time the family physician is a noble memory, particularly in urban centers. In suburban areas he is still extant but overworked, and in many rural communities no physician is available. Many people still cherish the myth of the all-wise, fatherly physician, as shown by the popularity of TV programs, particularly that of Dr. Marcus Welby who practically chases after the patient like a devoted mother after her child. Yet, when faced with a major illness, the patient will readily submit to the ministrations of the anonymity of the union health center, doctors in the group, or the assembly line technique of the Mayo Clinic and similar large teaching centers with the most advanced technology. In the twenty-five years since 1946 the doctor shortage has become so acute that many foreign physicians have been employed, their language and cultural barriers fragmenting even further the tenuous relationship between physician and patient. Medicine has been splintered into specialities.
When the surgeon, who is primarily interested in the logistics of the disease, finds that the patient presents emotional problems he will refer the matter to the internist on the case, and if the problem is relatively minor the internist 'handles' it; otherwise, he will refer the patient to a psychiatrist with the fervent hope that the patient will consent to the consultation. The skilled physician usually avoids delving into the dynamics of the patient's presenting emotional symptoms, and rightly so. This is one aspect that Dr. Bibring has insufficiently stressed in her advice to tak