"Cookbook medicine." That's what my doctor described the medicine of the future after health care reform. Because my daughter is entering college and thinking about a career in physical therapy, I had just asked the doctor about where she sees medicine going. She bases her opinions on what is already beginning to happen, not on theory.

"Politicians are addressing something that was never a problem," she explained. "They say it will give more people access to health care, but access was never really the problem. I should know. I worked in 21 different hospitals in my career, many of them in poor areas. We always saw people. They may have had to wait 24 hours for their sore big toe because someone else came in who was bleeding, but we always saw them."

The real issue is not access, but cost. To keep costs down, doctors will be required to practice medicine "by the book." The doctor explained: "We are given certain procedurs for, say, a stroke. And that's all that will be paid for. But there are all different kinds of strokes. Good medicine treats the individual as an individual. That kind of approach won't be reimbursed. The patients will suffer as a result of the new approaches."

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