In today’s health care system, one-time patient-physician encounters and brief interactions may start to outnumber long-term patient-physician relationships. In the absence of enduring, therapeutic bonds, ethical decision making takes place on less firm, less comfortable ground. Yet the innovations that encroach on the patient-physician relationship—sub-specialization, team care delivery, improved diagnostic and treatment technologies, hospital medicine, even the Internet—offer benefits that may offset the erosion of the one-on-one therapeutic connection. This month's issue examines the integrity of the patient-physician relationship at a time when its traditional underpinnings are being increasingly challenged.