I'm a recovering doc-aholic. A doc-aholic is addicted to the fantasy that he can make it alone just by working a little harder. Doc-aholics see themselves as healers in isolation, disconnected from peers, business reality and professional organizations. They accept contracts out of fear. They embrace the idea that "I'm a doctor, so I'll be okay. I'll just keep doing the same old thing and expect a different result."

I survived doc-aholism because I stopped, asked, listened and connected. I stopped accepting abuse as the norm. I stopped enabling a crooked system. I stopped complaining and reacting. I started to ask for what I wanted, and I'm clear about that. I say no to bad contracts. I ask to be paid for my value. I listen to patients, mentors, business advisors, family and peers. I connect with peers and professional organizations that feel the same way I do. I visualize something better.

In June 2005, when Integrated Healthcare Holdings, the owner of Western Medical Center Santa Ana, where I was chief of staff, sued me over a single e-mail critical of the administration, I felt isolated and terrified by the prospect of economic ruin. My legal fees reached $20,000 a month. The lawsuit was a SLAPP (strategic lawsuit against public participation) designed to intimidate and silence criticism of where patient-care dollars were going and how hospital finances were deteriorating. On June 14, 2006, the appellate court threw out the SLAPP lawsuit. I won, but not without enduring extreme personal harassment.

How we approached the struggle may help medical staffs looking to evolve and reinvent themselves. From the depths of despair, I connected with my colleagues in medicine. As a small, committed group, we analyzed our strengths and weaknesses, sought allies, mentors and sponsors, and created a principled plan. We executed the plan. Support from the Orange County Medical Association, the California Medical Association and the American Medical Association were crucial to our success.

And now whistleblowing doctors have even more protection through the efforts of the CMA. Just this October, CMA-sponsored legislation, AB 632, was signed by the governor to strengthen the whistleblower protections of Health and Safety Code 1278.5 for doctors. Physicians have a new shield to safeguard their ability to speak out on behalf of patients.

But a lot of doctors don't get it. They say, "That couldn't happen at our hospital. We get along with administration." My response is, "Oh yeah? See what happens when you try to follow the money and direct where it goes." Ask for accountability, transparency and reform. Suddenly, you may be labeled as "disruptive."

We doctors must convince administrations that diversity of opinion is beneficial. The joke goes: the chairman walks into the boardroom and says, "Now listen up, we're not going to have anymore 'yes-men' around here. Is that understood?" Isn't that what so many hospitals are looking for? Doctors who tell them what they want to hear?

If doctors don't ask the tough questions, who will? Who will advocate for patients? Who will reign in the rainmakers? I'll tell you who--doctors who aren't wimps, doctors who aren't doc-aholics. The Alcoholics Anonymous model will help doc-aholics: 1) We are powerless if we fail to cooperate; 2) Cooperating gives us strength; 3) We must use past errors to avoid future ones; 4) We must learn new behaviors; and 5) We must help others who have our addiction.

An independent voice, the medical staff organization should be funded through block grants and pay its members for their work. It has one purpose: to help doctors help patients. It should focus on mutual interests with the hospital and mutual gains, and use objective criteria to focus change. Medical staffs must overcome old rivalries and turf battles. Doctors must demand structural reforms: mandatory "meet and confer" conferences to resolve disputes with administration; resource allocation committees where doctors assign economic priorities; real government and Joint Commission oversight; and meaningful physician representation on the governing board.

As you know, there are problems with the current medical staff model that prevent us from getting there from here. We need a new paradigm. A regional physician corporation, explained on Page 22, is such a model. If you don't have the feeling of "Yes! Let's do this!" you may be depressed and in denial. Maybe you're a doc-aholic.