Timothy J. Pietro, MD, doesn't care much for the term "patient advocate." It sounds too adversarial for his tastes, too indicative of an implicit "us" and "them" whose interactions, without said advocate, would surely be injurious to said patient. It sounds too much like somebody itching to throw a punch, in other words. And that's not how healthcare should work, the Riverside urologist argues. The term "often leads to a mindset to ready ourselves for a fight," he says, "when the real fight for all of us is not among us, but rather a fight to achieve the same goal--a healthy mind and body." And besides, he says, there's no reason to label the obvious. "I think good physicians, by the very nature of their sworn duty, are to always be patient advocates," he comments. "I believe we were acting in that capacity long before that contemporary and overused term became so popular."

Dr. Pietro isn't the only Southern California physician who chafes a bit under the term "patient advocate." Doctors, of course, treasure their role as--well, whatever the best term for it is. It's the reason many doctors became doctors in the first place, in fact: to take care of patients, at every step in the increasingly confusing healthcare consumer experience. And, like Dr. Pietro, doctors hasten to note that physicians were, indeed, advocating on their patients' behalf long before that particular phrase came to be used for it. That's just what doctors do.

But physicians also recognize that the ground is moving under their feet, and that means the landscape is going to wind up looking very different in the future from the way it looks now. The relationship between patients and the healthcare system is changing radically, as the people who pay the freight keep changing the rules and as the technology behind the profession keeps upending the operational apple cart. And one of the key side effects is change--or the possibility of it in the near future--in the physician-patient relationship.

That's a good thing, patient advocacy-wise, says Tarzana dermatologist Dan Gross, MD. "I have no problem being a patient advocate," he says, "and that means informing patients what their options are if something happens between them and their insurance companies or government agencies that's truly not in their best interest." But, he says, he really wants patients to be empowered to advocate for themselves. "I think that's better for everybody," he says. "When I contact an insurance company, it's not going to be motivated to act positively on my request because it's going to have to pay out additional money. But patients do pay premiums, and without premiums, there is no insurance company. So I like for patients to be their own advocates. I'm happy to assist them and guide them."

For some doctors, though, it's all too much. And none of them speaks as eloquently on the topic as Howard R. Krauss, MD, a West Los Angeles ophthalmologist and the president of the Los Angeles County Medical Association. It's time, he argues, to clear out the clutter and move healthcare forward by returning to what made the system work so well in the first place: the absolute primacy of the physician-patient relationship. Indeed, one of his goals as LACMA leader is "raising physician and patient consciousness and uniting physicians and patients in the common vision of recovering and protecting the primacy of the physician-patient relationship across all modes of medical practice." He adds: "If we set aside the differences we have among physicians and focus on taking control back from for-profit health plans and returning it to the individual physician, in concert with his or her patient, we can accomplish a lot. But we get bogged down in petty fights with each other." As a result, he says, "we run the risk of delivering diluted messages to the regulators, legislators and media and thus neutralizing our own best intentions."