(part 2) Some very gifted colleagues are able to develop well oiled clinical machines that maximize productivity and address the ever changing administrative and regulatory demands regarding efficacy, accountability and credibility. Such "machines" are not fun for either the patient or the caring physician. A physician running a small business morphs into a businessman practicing medicine. We need one unified national template for rheumatologic disease oriented patient care regarding diagnostic, therapeutic, clinical monitoring and outcomes, functionality, quality of life, AE's and other evidence based parameters you discuss. Its time for 21st Century medical care. David Knapp, (retired rheumatologist)