The Change in Medicine:
1.    Most of the change occurs from the outside.  The pressure outside is beginning to influence the practice of medicine.
2.    How has the public been able to influence the theory that “physicians know best?”  Those who control the purse strings, have the most influence.
3.    Managed Care: the bottom-line theory as opposed to professional medical ethics regarding what is best for the patient.
4.    Physicians have known and driven their bedside, as opposed to boardroom decisions.  The most efficient care is the cheapest care.  The interest today is on the short term….