ABSTRACT
Practically every development in medicine in the post-World War II period distanced the physician and the hospital from the patient and the community, disrupting personal connections and severing bonds of trust. Whatever the index–whether ties of friendship, religion, ethnicity, or intellectual activity–the results highlight a sharp division between the lay world and the medical world. The organization and delivery of medical care almost guarantees that at a time of crisis patients will be treated by strangers in a strange environment. This circumstance has transformed many patients' behavior, encouraging a style closer to that of a wary consumer than a grateful supplicant. The first and most obvious of the structural changes that distanced patients from doctors in the post-1945 decades was the disappearance of the house call. The demise of the house call is a relatively unexplored phenomenon, but it reflects a combination of professional and technological considerations.
