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Medical practice is at the beginning of revolutionary change. But among health care professionals, feelings leading up to it are mixed. On the one hand, there is a sense of excitement because we are in the midst of momentous scientific advances, but on the other is a profound sense of frustration because we are experiencing accelerating costs and a realization that we in the U.S. are not only inadequately serving our population's needs but are seeing the quality of our health care declining relative to other industrialized nations. Two years ago, attending my fiftieth medical school class reunion at Columbia, I encountered a remarkable instantiation of similar mixed feelings. Virtually everyone had answered