At this time of the year, reflection on times gone by is a natural pastime. Although the pace of change in our world seems to have accelerated to a frantic pace, the end of the year, with its time-honored holidays, allows some of us the reassurance of continuity of traditions, family and peace. This year, it is more evident than ever before that the practice of medicine is inclusive of both reassuring tradition as well as simultaneously exciting and frightening technological change. This dialectic will likely define the future of medicine in America and the role our profession will play in that future.

Like most major changes, there are more questions now than people with answers. Nonetheless, if we don’t start to identify the real goals of this change in healthcare, we will be reliably disappointed by the usual human motivations of money and power. Hence, if the key sources of the existence of the medical profession stem from both knowledge and trust, we need to understand, articulate and tirelessly advocate for change that tests, refines and disseminates these essential elements. For example, the national introduction of the electronic health record could be made “meaningful” by requiring improved communications between physicians and patients.

The national EHR stimulus could have a required outcome of presentation of quality and outcomes information to every physician in America, enabling specific improvements in practice and operation in service of our gift of trust from our patients to always provide them the very best care. This countrywide technological transformation of the practice of medicine also could enable a new era of medical research of knowledge dissemination to clinicians, where we understand and embrace the use of these new information tools not necessarily to eliminate the products of Gutenberg’s invention, but to augment and go beyond them (please put down the cellulose).

Or, we could wait for others to convert this vision to one of computers designed to capture administrative, financial and regulatory compliance information only, distractions in the exam room and constant reminders of how the administrative overhead of the practice of medicine has, for us and all too many of our colleagues, driven so many to the cessation of practice.

This bleak “Terminator”-like vision is not inevitable. However, the most important elements for the medical profession to alter that trajectory are still to rarely in evidence: 1. understanding, and 2. involvement.

My friends, it is in no way enough for you who are reading these words to be the only ones involved in this awakening of American Medicine. It IS our responsibility to communicate, advocate, enlist and educate our colleagues throughout this country that what is at stake here is not just the dissemination of dollars and equipment, but the very survival of the core strengths and legacy of the practice of medicine for our patients’ sake, and none other, in the United States of America.

The time to get the word out is now. Too much depends on this for us to fail.