Dr. James proposes to look at the position of Medicine in modern American society. Medicine is a subsystem of the overall culture and society and thus is subservient to the politics and economics of its society but "always functions within the context of the values, attitudes, and beliefs of the people who comprise that society." Dr. James summarizes the 1950 book "The Lonely Crowd" from which the Oration takes its title and in which the author, David Riesman, writes about various types of social character which reflect different phases of development of societies. From "tradition directed" in primitive societies through "inner directed" in transitional societies the character finally evolves to "other directed" in our society where individuals look to others for signals about how to feel and act. Without internal standard codes of behavior or stable beliefs the population is a "lonely crowd."
Of some aspects of our society that affect physicians, Dr. James echoes sociologists who point to a decline in Religion and subsequent loss of a unified and pervasive system of behavior and philosophy. This leaves cultural and Medical ethics in a state of confusion. Science has not replaced this loss, and indeed, there is a popular backlash with a mistrust of Science and Technology. In this same vein, the introduction of the computer with its control of many aspects of our lives leads to depersonalization. Sociologists have also pointed out the decline of the family, emotional impoverishment, lawlessness, consumerism, and narcissism as factors affecting modern culture. Particularly, with an increase in Materialism and its focus on economics the greatest pressure on Medicine is the criticism that is costs too much.
In this societal context of a bewildering time and bewildered people Medicine must meet the challenge of political, social, ideological, and economic pressures. Dr. James proposes responses in four areas. "First and most important, physicians must rededicate themselves to the care of the patient and must reassert the primacy of the patient's interests." Secondly, "the physician must be properly educated for these difficult tasks--not programmed, not trained, but educated." In this regard medical schools must keep humanistic concerns in mind but the physician must also be a scientist in the broad sense, able to translate science to his patients and use it for their benefit. In the third approach "the physician must become socially involved to a greater extent than has been customary," serving the needs of his community as well as that of his patients. Finally, "physicians must join appropriate medical organizations in order that their voices may be heard and opinions registered." Dr. James feels that the American Medical Association still speaks with the loudest and clearest voice though a number of other organizations also deserve membership. Recalling William Osler's farewell address, Dr. James concludes that equanimity remains a most important trait.