Dr. Charles H. Epps Jr., 55, is chief of orthopedic surgery at Howard University Hospital and former president of both the American Orthopaedic Association and the Medical Society of the District of Columbia. His wife, Roselyn Epps, is a pediatrician. He was interviewed by Don Colburn.

For a black pre-med student in the 1940s, there were basically two options: Meharry Medical College in Nashville and Howard. I grew up in Baltimore, but it never entered my mind that I would go to medical school there. To me, Johns Hopkins and the University of Maryland were not an option.

I didn't get into pharmacy school, because I applied too late. But my high school biology teacher -- really a surrogate father -- advised me to come to Howard and major in chemistry. My first year went so well that I said: Why not shoot for medicine?

To get through medical school, I drove a taxicab for four years. Capitol Cab No. 444, a 1951 Plymouth, black with orange letters. The man who sold me the car was very nice. During final exams, he'd forgive my note for two weeks and let me double up on payments.

It was a very hard time. I didn't enjoy medical school, but it taught me a healthy respect for hard work. To this day, if I walk along the street and see a penny, I pick it up.

In those days, what most doctors wanted was to have their own office with a sign out front. I hung up my shingle on Georgia Avenue. That doesn't happen very much today. We're facing the industrialization and commercialization of medicine. The era of the solo practitioner is gone.

My first office visit fee was $10. Most people didn't have third-party coverage. They paid out of their pockets. I've always accepted Medicaid patients. I would consider it an act of social alienation not to.

The biggest change in medicine is in the public esteem of doctors. There was the illusion that doctors were deities. People realize now that doctors are human, like everybody else.

And there's been a great intrusion of technology, which has to some extent overtaken the art of medicine. The old doctor had nothing but time to treat pneumonia with, so he sat at the bedside and held the patient's hand through the crisis. Today, he writes a prescription for antibiotics, and that's it.

When I was a kid, almost all the kids were born at home. The doctor came, and they got hot water and newspapers and put the kids out in the yard to play, and when you came back in, the little brother or sister was there. Unfortunately, technology also raises the cost of medicine. I'm sure if they invented a better tongue blade, it would cost more.

I think the malpractice crisis has had the most harmful effect on the practice of medicine. It has put the doctor in almost an adversarial role with his patients. You're always looking over your shoulder. There's always the threat of a possible lawsuit.

I don't think most people realize that most doctors agonize over their patients. Whenever I lose a patient I go through a period of grief. You learn not to let it destroy you, but you agonize.

It's hard to get bored doing orthopedics. We're doers. We like to fix things. Whether it's the back, finger, foot or shoulder, we want to make it work right. I loved to tinker when I was a kid. When the radio or the clock didn't work, my mother would hand it to me and I'd pick it apart.

Nothing pleases me more than to see a fracture fixed properly. A patient comes in after an accident, with multiple injuries and broken bones, and one day he walks out of here.