Rodney Ellis, 37, has been an internist at Group Health Association since 1978. He and his wife, who is a gynecologist in private practice, live in Fair Oaks, Va., and have four children.

I decided to go into medicine at a very young age. And over the years, I guess reflecting my maturation, my reasons for wanting to become a doctor changed. At first I wanted the glamor and the prestige of driving a Cadillac, seeming wealthy. I guess during the '60s, when I was growing up, I thought it was a very noble and good thing to do. And I guess more recently I simply enjoy the privilege that it is to take care of people.

I chose an HMO health maintenance organization because in my first-year residency I thought that it was a very nice way to practice without having to worry about collecting bills. And I wanted to be able to take care of all kinds of people, working class and upper class people. What I really want to see is having prepaid medical care available to all segments of the population.

The alternative that I'm concerned about . . . is having a national health care system such as exists in England, or on a small scale right here in this country with the VA Veterans Administration system, where there aren't incentives, everything is grab-and-go, there's a lot of bureuacracy, a lot of boredom.

I had a patient who has so-called sleep apnea syndrome, a very interesting syndrome, in which because of his obesity, he's unable to sleep well at night because he chokes himself off and stops his restful kind of sleep, called REM sleep, and awakens throughout the night. This man actually had to have a tracheotomy an opening cut in the throat in order to breathe, but at the same time was so concerned about having to have the tracheotomy that he lost a lot of the weight. And we allowed the tracheotomy to close because he was doing relatively well, yet he has allowed himself to fall out of his weight-reduction program. He's put on a lot of weight again, his blood pressure's gone up, and I'm afraid that the sleep apnea syndrome will recur.

It is very frustrating. It's a real challenge to get him to see that he's being self-destructive. It's not just like something's happening that's out of his control. He has to see that he's given up on himself. And that's frustrating.

I get the sense that, especially nowadays, it's more an economic issue with patients -- what benefits will a particular health plan give them?

I think that there are aspects of medicine that I would still call an art form. But I think that that sort of art form can be found in other areas. I guess you'd have to think of it in terms of psychotherapists, or in terms of spiritual advisers -- the ability to be with people and get their confidence and sort of recruit them in their effort to be well.

That's the art of it. Having a bedside manner and giving confidence to people so that they will in fact get better, know that they will get better. Because it really does help. I think it does make a difference.