Dr. Halpern begins and ends with the bedside dilemma of the caring physician, who must make difficult judgments on behalf of patients who are already anxious, angry, in pain, or depressed. The prevailing medical wisdom assumes that such judgments are best made from a position of detached concern, what Halpern describes as "detachment with a veneer of tenderness" (p. 25). Patients’ emotions do not directly indicate the extent or nature of their underlying disease—the expression of pain, for example, derives from culture, expectation, and past history as much as from degree of tissue damage. Physicians’ emotional responses to patients are similarly idiosyncratic. To achieve reliability, objectivity, and reproducibility in medical intervention, the argument goes, the physician must learn to factor out all these unique elements and rely on the evidence of controlled observations of group responses.