The sick man was a misery to himself and to everyone around him. For one thing, his personal hygiene was horrific. He stank. And he was constantly in pain, moaning and groaning until you began to wonder if he was doing it just for effect. Worst of all, he was a mean old cuss, angry and embittered after years of illness. All he did was complain.

A few dozen medical students, most of them in their first year at Weill Medical College of Cornell University, listened with concern to a presentation about him a few weeks ago. Eventually, they knew, they would run into difficult patients like this one.

The sick man had been a mover and shaker once, with a place in high government circles. But then he had the accident. His wound became infected. It was all downhill from there. He quickly became unable to work, and his distress upset everyone around him. Finally, his business associates forced him into long-term residential care.

Some of the faculty members in the conference room nodded in recognition. It was a case right out of a chronic-care ward in a Veterans Administration hospital.