"It's hard to offer advice to my colleagues who are thinking about how they are going to change over time as healthcare is reformed, because it's a regional phenomenon. Having worked with multiple systems, many things are the same, but many are vastly different. This is more about culture than it is about medicine, and changing how people work together to improve the health of individuals has to be the common goal. Rather than fighting it or making care more uniform, my strong recommendation is to understand those cultural differences and use them to the advantages of care. Efforts by consultants to institute the same care protocols can be good for the patients if it is done in a sound, intellectually meaningful way to those who are providing the care, but I want to look carefully at uniform care protocols around the country. The healthcare environment is in rapid change based on consumer needs and preferences and that will happen, regardless of what's happening in Washington."