Since "Heartsick" was published, more than 30 letters from physicians all around the United States have come to me: poignant stories, advice to "make each visit count with patients," two job offers, a book (The Lost Art of Healing by Dr. Bernard Lown), a symbolic hug sent in a delightful letter from an internist who hastened to inform me of his grandfatherly status. Many were counting the hours until retirement. Only one other physician had gone off on his own, as Dr. Hassell has. From these letters I felt an affirmation, and clarity about what my next step would be.

I am writing a letter to all my patients, explaining my philosophy of care and outlining a revised daily schedule that gives me more time with patients. My template each day will soon resemble Dr. Hassell's. I've been told that I'll make less money, but I'll make the tradeoff gladly. Having done this one thing has ended my heartsickness.

Dr. Hassell should be proud of what he has achieved. And in his exhortation to "take the high road ... don't participate," he asks us to reject "serfdom." But his solution and mine are private ones, exhibiting our profession's pioneer individuality that makes every physician an island, and every decision a personal one. We can't all go it alone, either in our practices or our professional decisions. Something more is now required.

I have left several jobs for the reasons Dr. Hassell mentioned. One staff-model health maintenance organization was tolerable for only a few months. Right now I am not forced to sign contracts or honor gag laws. I now choose to stay and fight within my system to prevent patients from being reduced to "covered lives," to advocate for a reimbursement scheme based on principles of caring for the patient, on quality and continuity of care. I want to continue the research I have started on the work lives of physicians and to document time pressures as well as the deleterious effects of market forces on the practice of medicine.

I have a dream of physicians banding together like an ancient guild to protect a venerable and precious calling. It is up to us to stand up, both individually and collectively, to preserve medicine as a healing profession, not an "efficient" and profitable business. I hope Dr. Hassell will stand up with me.