A FINAL EXAMINATION The basic premise of A Final Examination is that as I approach the later stages of fifty years of a life in medicine I have borne witness over the last generation to what would appear to be the gradual decline of family medicine to the point of imminent dissolution. I am well aware that this reality does weigh heavily on my heart and soul as a physician and for that matter throughout my being. I composed a memoir as what seemed to me the most accurate way to dramatize the nature of this loss - beginning with looking at the genesis of my life in medicine, i.e. where doctors come from, and an extensive and personal look at the context and content of a doctor's life, leading to the magic that can occur between doctor and patient. I am a private person. I have always valued the anonymity with which I have been able to live to work and work to live. I want for nothing that I do not already have, certainly not any form of public visibility or recognition. But what other form of revelation can substantiate my plea for concern about medicine's future than one based on open and honest self-revelation, one in which many of my patients also generously have joined in? Who might want to read this book? If you have never had the need for the intimate and trusting support of a competent physician, you will be fortunate to reach your life's conclusion and be able to continue to say the same, as we all will become older, we all make errors of judgment, we all suffer misuses and abuses, we all meet with disease in some form - thus it is to be human - all of us, every manner of doctor included, eventually need a doctor. And this makes the possible disappearance of the traditional dynamic between doctor and patient in all of its manifestations relevant to us all. When you need to make your call, you will not want the medical profession to be as hollow and empty, as antiquated and obsolete as a telephone booth with a dangling defunct phone. At least the telephone booth was replaced with a new and better technology. Does anyone else out there think that our era is so rife with challenge and despair that it is no longer within the power of individuals and committed groups to envision and work toward positive change? The best of our forebearers, many of whom I reference in A Final Examination rejected that thought entirely. It would be my preference to do the same.