The competencies and safety.

American medicine has evinced a tradition of technological mastery, curative breakthroughs, and unlimited resources. At times, both public opinion and media attention have fostered this perception. From Marcus Welby, MD to ER, the media has depicted the physician as a highly competent practitioner armed with space age gadgetry and, of course, miraculous cure-producing abilities. Popular culture has treated neurosurgery in much the same manner, often as paradigmatic of the dramatic accomplishments of modern medicine and surgery.5 Recently, however, a number of societal trends have disrupted traditional attitudes toward American medicine: