Professionals are not supposed to feel desire or disgust for their clients, and they presumably begin to learn "affective neutrality" in professional school. Medical students learn to manage the inappropriate feelings they have in situations of clinical contact with the human body, but two years of participant observation revealed that the subject of "emotion management" is taboo. Yet the culture of medicine that informs teaching also includes a hidden curriculum of unspoken rules and resources for dealing with unwanted emotions. Students draw on aspects of their training to manage their emotions. Their emotion management strategies include transforming the patient or the procedure into an analytic object or event, accentuating the comfortable feelings that come from learning and practicing "real medicine," empathizing with patients or blaming them, joking, and avoiding sensitive contact. By relying upon these strategies, students reproduce the perspective of modern Western medicine and the kind of doctor-patient relationship it implies. How do I set aside 25 years of living? Experience which made close contact with someone's body a sensual event? Maybe it's attraction, maybe disgust. But it isn't supposed to be part of what I feel when I touch a patient. I feel some of those things, and I want to learn not to. (Third-year, male medical student.) All professionals develop a perspective different from, and sometimes at odds with, that of the public (Freidson 1970). "Professionals" are supposed to know more than their clients and to have personable, but not personal, relationships with them. Social distance between professional and client is expected (Kadushin 1962). Except for scattered social movements within the professions in the late 1960s and 1970s that called for personal and egalitarian relationships with clients (Haug and Sussman 1969; Kleinman 1984), professionals expect to have an "affective neutrality" (Parsons 1951) or a "detached concern" for clients (Lief and Fox 1963). Because we associate authority in this society with an unemotional persona, affec

Patients prefer end-of-life discussions earlier and with greater honesty than physicians may perceive. These discussions are inseparably linked with the patient-physician relationship. Physicians can better address patients' desires in end-of-life discussions by altering their timing, content, and delivery.

A majority of experienced medical students did not assess several important risk factors of a patient concerned about HIV infection, and many would have provided incorrect information related to HIV testing and prevention of infection. Patient contact in traditional clinical settings did not influence prevention knowledge or behavior. More innovative methods are needed to train students in HIV-infection prevention and counseling.

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The lack of difference between the groups' clinical performances indicates a need to more rigorously define and evaluate outcomes of education in ambulatory care settings. The generally poor clinical performance of all groups suggests that the current curriculum inadequately teaches clinical skills needed to assess and manage common problems. Clearer expectations of competencies and assurances that preceptors in ambulatory care settings will help students meet those learning objectives might lead to better outcomes.