Has medicine an essence?

Introduction. - Medical practice has to move from a one-on-one relationship to consensual organization of the overall management of patients. Issues a t stakes and potential consequences following such changes are discussed Exegesis. - The evolution of medical practice is introduced as a necessity resulting from both improvements in medical technology and economical press ure. Utilization and procedural doctrines are promoted, taking the place of ethical bases. The one-on-one relationship evidences two essential aspects : there is often more in the request made to the practitioner than just the expression of an immediate need, and the patient is not only an organism. Both aspects reflect the specificity of human beings. There is a danger tha t the will disappear, as they are not included in the definition of "useful ", which in fact controls current choices. Conclusion. - Medical practice is radically modifying its own basis. Practi tioners who acknowledge these changes should be aware of their cost. (C) 19 98 Elsevier, Paris.