Two powerful words - guts and determination. I know you're wondering why they should be used in the same vein as health care. Unfortunately, it's because of the world that we now live and practice in. It takes guts to say what you believe is best for a patient, on so many levels. It takes guts to oppose the status quo with our patients and their families, to tell them the newest designer drug is not going to cure their obesity or poor health habits. Contrary to the never-ending drug company advertising, life will never be all flowers, endless orgasms, smiles and happy fields of dreams due to the newest ED med or antidepressant, if patients don't make some critical life choices for themselves. It takes guts to tell it like it is, to really separate the valid life advice from the endless barrage of crap hurled at patients day after day. This, I believe, can be the only true way out for all doctors in private practice today. And a big win for everybody. Society will win. Not all of it, of course but much bigger segments. Crisis-based health care expenditures would drop like a stone if we helped to prevent, or at the least reduce the complications from heart and vascular disease, depression and chronic back pain, and diabetes to name only a few. And doctor, if you are in alignment with my philosophy, continuously developing your perfect practice, you are already well on the way to making this a reality. And what happens if we all practice this way? Once again physicians of all disciplines become the real decision makers. We decide collectively to continue to be teachers, and leaders by example. Refusing to back down to third-party based interests and administer only to the patient's needs first. Not to the insurance companies or drug companies or hospitals. To truthfully stay as Commanders of Change will takes guts. By simply being a good doctors first, one patient at a time, regardless of which initials you have at the end of your name. But, to do this for any period of time requires very powerful support systems behind you. It can be stressful, unfulfilling and eat you up otherwise. As a consultant, I see this firsthand. First is your beliefs (guts and determination) and personal lifestyle. Beliefs about what constitutes true health, self-reliance, responsibility and innate intelligence vs. an artificial intelligence and dependency. Second is money. What is your care and advice really worth? What about those who can't pay? Third is having a staff that supports your vision. And finally, it's having powerful and extraordinarily effective systems and technology. But doctor, none of this can ever work without a powerful philosophy that you can communicate. Patients must know what you're about. They need to feel it. I'm not saying you should be flamboyant or radical. In fact, this turns way too many people away from you whom might otherwise benefit from your care. But I am saying you must clearly stand up for what you believe. Never forcing, but presenting, supporting and helping those patients and staff who can align with your purpose and vision. And gently getting the rest out of your life. It just takes guts. But, here is the reward. In the long run, you will be much happier, more prosperous and healthier yourself. You will help more people. Have a much broader reach. Patients and indeed the entire community will want to see only you. Yes, even in today's world.