This article examines the ends to which technology are employed in the office practice of medicine. It argues that the types of decisions technology supports are of greater impact on how medicine is practiced over the long view than the actual technologies themselves. The more relevant the technologies are to the effectiveness of diagnosis and treatment, the more they drive the practice of medicine toward a standard endeavor. Similarly, technologies that make existing tests and procedures more efficient often reduce the skill level that is needed to provide care. The results of these forces coupled with the increasing administrative, economic, and regulating pressures lead to a diminished role for physicians unless a conscious effort is made to introduce technologies that enhance their unique and discretionary work with patients.