Table of Contents

To introduce the articles in this issue, which treat the ways time shapes the theory and practice of medicine, this essay surveys developments in thinking about the nature of time from the beginning of the 20th century.

What patients believe about time has much to do with their notion of health and medicine. Synchrony of time sense between physician and patient shapes the objectives and the content of care and compliance; asynchrony leads to frustration and failure.

Does the aging process have some purpose, and to what extent can we control what are otherwise inexorable consequences? Although various philosophical traditions have offered different interpretations of the relation between age and time, a more unified concept of human aging may be emerging.

As the 21st century approaches, time is disappearing from the process of teaching and learning medicine, with disturbing implications for the quality of education. Medical educators in the future must work as hard to defend the availability of sufficient time as they do to acquire new buildings and research funds.

This essay explores how chronologically linked indices of health and illness achieved clinical and scientific significance and examines why time has been a potent concept through which key associations among the data of medicine are ordered and revealed.

The study of events in time is fundamental to biomedical research and public health surveillance. Research designs that incorporate time have long been in use, and new statistical methods have been developed for enhanced analysis of longitudinal data. In the next millennium, these designs and methods will continue to evolve and will provide better, sharper answers.

It is almost impossible to represent and analyze clinical data in the absence of a temporal dimension. This paper emphasizes the crucial role that tasks of temporal reasoning and temporal maintenance play in modern medical information. It also discusses the implications of providing automated support to clinicians who must perform such tasks as part of broader clinical activities.

When I discovered that I had cancer 1 hour and 40 minutes before leaving for Paris, I was transported into an eerie seam between thought and feeling.

When a life-threatening or chronic illness is diagnosed, patients may find that their sense of time, the passage of days, and their view of the future are altered. They move from a sense of linear time to a sense of soul-satisfying time, and they begin to see life more in terms of cycles of daily events, routines, and the change of seasons.

This essay examines the medical charts of two patients. As a repository of detail not only about the patients but also the doctors and nurses who cared for them, the charts provide rich and powerful evidence about the insides of practice and the meanings that clinical relationships accrue.

Now 91 years of age, Dr. Paul Beeson embodies the caring mission of medicine. In this interview, Dr. Beeson discusses his memories and thoughts about 20th-century medicine.

Pressures on physicians' time have intensified over the past two decades as a result of managed care, more demanding consumers, complex new technologies, and administrative burdens. Why is physicians' time under assault, and what does the future hold?

Some elements of medicine have been part of the profession throughout time. These characteristics will necessarily bend in response to scientific and social pressures, but they must remain firmly rooted if physicians are to uphold their duties to hopes, lives, and the future.

Medical care moves through time, a choreography for the dance between patients and their caregivers. The essays on time and medicine in this issue reveal a spectacular array of alternative views of time and of ways that medicine intersects with time's many facets.

As befits this new year, this new century, and this (almost) new millennium, an entirely new electronic version of Annals is currently under development and will be up and running several months from now. What will be new about the new e-journal? Nearly everything.