External factors will continue to impact on the shape of medicine in the coming decades, requiring careful monitoring and consideration. These developments may need to be given greater attention in undergraduate and postgraduate programmes – possibly within the ‘hidden curriculum’. One of these is the ‘physician-patient’ contract. Jacalyn Duffi n, a Canadian practising haematologist, educator and author, reminds us that historically ‘[a] contract has always existed between physician and patient, although usually it was not recorded in writing’.200 Failure to meet expectations has ranged from the severe to ‘fi nes, revocation of the licence to practice, and jail’. However, the patient-doctor relationship is changing to a large extent because of the public’s awareness that there are limitations of medical knowledge and confl icting treatments.