Singular beneficence? Presidential address to the Ulster Medical Society delivered on Thursday, 14 October 1999.

In 1900 Sir William Osler, who was the dominant figure in medicine at the beginning ofthis century, stated that medicine is distinguished from other professions 'by its singular beneficence'.' In the title of this address, a question mark has been added because 100 years after Osler made this comment, it is worth reflecting on whether medicine has lived up to his views, and what future medicine will have in the years to come. In 1949, Lord Horder, a leading London physician asked the question 'Whither Medicine?' His answer was 'whither else, but straight ahead'.2 Today, 50 years later, do we know where straight ahead is? It is important to consider where we are going in the next few decades, and most important for those who have responsibility for educating the doctors who will practise in the new century. What was medicine like at the beginning of this century? Two paintings of the time give us some information. The first, the 'Doctor's Visit' by Thomas Faed, belongs to Queen' s University and hangs in the foyer of the King Edward Building at the Royal Victoria Hospital (Fig 1). Painted in 1889, it shows the doctor calling at the home of a patient, a man who is clearly very ill in bed, attended by his wife, with a child nearby. At about the same time, in 1891 Sir Luke Fildes painted the picture entitled 'The Doctor' which hangs in the Tate Gallery. Here the doctor is within the home, the patient is a child, and the family is in attendance. A feature of both these portraits is that the doctor comes to the patient's home, what would now be called 'care in the community'. The doctor does not have a bag full ofdrugs or a prescription pad. What he has is time to spend with the patient. What would be the picture of the doctor today? The television programme 'ER', is perhaps somewhat theatrical but nevertheless illustrates a public perception of medicine. The doctors are young, full of Fig 1. 'The Doctor's Visit' by Thomas Faed, painted in 1889. This painting is part of the Queen's University of Belfast collection and hangs in the King Edward Building of the Royal Victoria Hospital. enthusiasm, surrounded by high technology, with, as a badge of office, stethoscopes around their necks. Medicine has advanced enormously in the last century, particularly in the last 50 years and …