IN 1977 A gastroenterologist named Franz Ingelfinger had cancer, a cancer that originated in his gastroenteric tract. He was perhaps the most informed patient imaginable, but that year he presented a lecture at the Harvard Medical School in which he reflected on how difficult it had been to find someone who would take charge of his care when deciding what treatment course to pursue. 

Ingelfinger had already had surgery to remove a tumour but could not reach a decision regarding various possible chemotherapy regimens and the question of whether radiotherapy would be useful in treating potential metastases. As former president of the American Gastroenterological Association and editor of the highly regarded New England Journal of Medicine, he had the finest minds in his profession at his disposal and fielded opinions from many learned colleagues regarding his best course of action. These opinions became so numerous and contradictory that he grew ‘increasingly confused and emotionally distraught’, as he put it. A friend who was also a physician suggested that what Ingelfinger needed was to find a doctor who would ‘in a paternalistic manner assume responsibility for [his] care’. Only when Ingelfinger followed this advice was his distress alleviated.