This is a great insightful and provocative video Jack. Another change I would advocate for is that rheumatologists be more quantitative in their assessements of patients with RA, SLE and other rhuematic diseases. Whatever problems we may have with EMRs, they do allow for better tracking of quantitative clinical and lab data- important in T2T strategies. Also we need to be more selectively quantitative in our assessment of patient adherence to therapies by measuring blood levels when indicated. For instance in a patient not doing as well as one would like on MTX 15 mg weekly, rather than jumping immediately to a biologic why not measure MTX polyglutamate level? If low then check if the patient is really taking it appropriately and consider switching to SC at the same or a higher dose. In some instances, this would help the patient and would reduce the use of expensive and possibly unnecessary biologic therapies. Just my opinion.