Because I work with women afflicted with infertility, my patients are either elated when their pregnancy tests become positive or disappointed when their menstrual flows begin. As time progressed, I questioned what I was really providing as a reproductive endocrinologist. If my product was a pregnancy and ultimately a baby, then what was I providing to those who test negative?

Perhaps those of you in oncology face a similar dilemma--either your patient will respond to your treatment or they may die despite your treatment. This positions a physician as either a hero on a pedestal or the one who failed the patient. It can be an emotional rollercoaster for both patient and physician.

Using a business perspective, I tried to think of my services in a different way. What was I selling? What was my product?

Obtaining a successful pregnancy is one product. Delivering a healthy baby is another. So one might say that regardless of the pregnancy outcome, I was selling hope. But hope is only unrealized expectations. Moreover, how long can one live in the world of hope? So there had to be something more.

Maybe I was selling conflict resolution. Either she gets pregnant or not--and I have resolved her conflict. That also seemed to work for a time, but then I realized that my product was not clearly defined, nor did it seem fulfilling.

If the patient becomes pregnant, her life will change because of the baby. If she can't get pregnant, her life will also change because she can put aside the conflict and move on to a new phase. Over time, it became clear that my job was to facilitate her transition through these changes. I began to understand that my real product was change. I can guide my patient to motherhood or to a life of initial grief followed by fulfilling challenges without children.

Defining your product and what you do everyday as a caregiver will not only position you as a successful physician, it will assist you in becoming a more effective contract negotiator with managed care companies. Understanding your product compels you to develop a vision of your role in the healthcare business.

To encapsulate this idea, I share a modified quote in The Daily Drucker from Peter Drucker: "In a period of upheavals, such as the one we are living in, change is the norm. To be sure, it is painful and risky, and above all it requires a great deal of very hard work. But unless it is seen as the task of [the physician] to lead change [in the patient], the [physician's practice] will not survive. In a period of rapid structural change, the only ones who survive are the change leaders. A change leader sees change as an opportunity. A change leader looks for change, knows how to find the right changes, and knows how to make them effective both outside the [practice] and inside it. To make the future is highly risky. It is less risky, however, than not to try to make it."

So what do you sell? Hopefully, you won't just say healthcare or hope or conflict resolution. Join me in the change business. In that context, we can speak with confidence about what we do when selling our product to managed care companies. We can create better ways to bring healthy and emotionally satisfying change to the lives of our patients as we look beyond disease management. And we can speak assuredly about the whole person.