We were told that T2T came about because of distain of physician gestalt. The first principle was shared decision making with the patient and the physician. Except we have been doing that for centuries. T2T has some important aspects but there is a lot more to take into consideration for patient care. Our Disease Activity measures are inept and made worse by ACR indicating the DAS28ESR and DAS28CRP results are supposed to be identical. My physician gestalt does not accept that. Physician gestalt is physician judgment. Remember you are supposed to use T2T to decide to change your medication and treatment program. Well if you how do you choose? Oh yes, you use "physician gestalt!"