Jack-I appreciate and agree with your impassioned presentation in RA2. The word idealistic comes to mind (we all can't be a Ghandi), Your entreaties remind me of the Old Testament Judges and Prophets warning the royal and clerical leadership of the consequences for not following Mosaic law and covenants and their unwise political choices. I do not not think much will change as long as the current "one-on-one" patient care approach characteristic of a small business prevails. A team approach to patient care directed by the physician that fully engages and empowers the patient to participate is needed to meet the clinical demands of healthcare and address many of the issues you raise regarding evidence based disease measurement, management and outcome. The patient must be involved in their care and decision making. Even the most conscientious clinician soon gets "ground down" by the relentless demands for productivity, efficiency and "patient satisfaction". Ultimately, short cuts develop that limit intellectual honesty and critical thinking. (part 1)