The specialized clinic and today's medical care needs.

At one time it was unusual for subjects like "MIedical Care Needs," or "Clinic Reorganization" to be dealt witlh in scientific journals. Professional groups, (internists, pediatricians, surgeons) now give such practical matters a corner of their program andl one or two rooms at the conference. The scientific journals follow along. This is part of the new temper of the times: challenge in social conflict, demands from classes and groups not previouisly heard from, an earnest search for relevance in professional roles, and, inot least, a different division of the spoils. M\ore money is gradUally being directed into tlle service sector of the medical care field, conmparatively less into researclh. It is almost 5 years since Jolhn Gardner stirredl the country with hiis statement on the crisis in the cities and soundled the proplhetic note that "the times cry ouit for clhange and ouir instittutions resist change witl tunloly stubbornness." Thle institutions lhave begun to search for ways to display concern, give recognitioin to the crisis wlhile ptLirstiiiog liscreet, (lignified ways of avoidling clhange: no confrontations, of course, aInd very little clhanige. The medical scllools and teachinog lhospitals lhave not been totally unresponsive. In the lhealtlh field, a great (leal is lheard abouLt the needl for family practice, for revamping medlical edtucattion. And these are real needs. Yet there is a strange silenice about the role of the specialists and their powerful influence on medical c(tdcation expressed in that muajor educatioinal tool tlhe specializecl clinic. The problem of the specialized clinic an(d the modern mainagement of ambulatory care is an intrinsic pairt of the problem of inadeqtuacy in the medical ('are system. Every specialist or suLbspecialist-in medical practice has a vested interest in the specialized clinic as it Inow exists. The specialist knows tllere is a neecl for hiis specializedl skill an(l lhe is impatient witlh those wlho would lhamper hiis efforts to study an(l treat that needl in "hiis' patients in the way lhe thinks best. Despite this skill and the specialist's categorical interest in an important field, it may Ie that consideration cannlot be limited to one aispect of service in meeting me(lical nee(ds. There is a larger frame of reference, andl the interdependency