[Changes in the environment of medical practice].

Changes in medical practice have been very deep in the last 50 years. These changes have happened together with other external variations in the economy, demography, culture and information, generating a sense of uneasiness and unhappiness among the medical profession. This problem is visible when interviewing clinicians in a wide range of medical settings, independently of their contractual arrangement. The medical work model in Chile has changed from a situation in which there was a sole employer, the National Health Service, one single training school, the University of Chile, and a small minority of powerful and influential intellectual leaders. At the beginning of the XXI century, there are several modes of medical work, distant and unconnected among them. On the other side of the problem many factors add complexity, such as the demographic and epidemiological transition, technological advance, the dual rich-poor medical care, the emergence of malpractice procedures and the new, better informed and more demanding medical consumer. On top of this, different health care systems reform initiatives appear, providing more uncertainty to a nearly unbearable situation. This bibliographic review shows us that similar feelings are experienced in advanced countries and in developing societies such as Chile.