In May, the idealistic clown Patch Adams, MD, spoke at the Pri-Med conference in Anaheim. In his speech on "The Joy of Caring," he mesmerized the audience with a compelling message: The privilege to care for others outweighs any other consideration in the healing arts.

There stood Dr. Adams--clown, political activist, humanitarian and advocate for peace--with the same academic credentials as me, but on a very different course in life. He eschews the trappings of "American success," claiming he owned no possessions, carried no insurance (health, life or liability) and proudly avoided technology. He denies any specific religious belief, but gathers around him people dedicated to caring for the poor in more than 66 countries afflicted by war, famine and natural disaster. Speaking without notes or a PowerPoint presentation, he enthralled the physicians for an hour that seemed only a few minutes long. For the first time in my 35 years of attending scientific medical meetings, a presenter received a standing ovation.

Dr. Adams stated that physicians should never suffer burn-out if we focus on the giving of ourselves to assist others to restored health and a sense of well-being. Yet, I struggle. I believe I am not alone in facing the difficult choice of a path between total altruism and self-indulgence. In my generation, the epitome of selflessness is Mother Teresa of Calcutta. And my award for self-centeredness goes to Paris Hilton. We must all ask ourselves: Where in that wide swing of the pendulum do I fall?

Here's another example of a struggle I face as I try to determine where I fit. Let's look at a recent story from Toronto, which dispels the myth of the great Canadian health plan. John, a man in his mid-60s, presents to his physician with neurological changes consistent with a cerebral neoplasm. His doctor referred him for a diagnostic MRI, which was estimated to take a minimum of four months. Through a different referral, John travels to Buffalo, N.Y.-a one-hour drive-and obtains an MRI brain scan confirming the malignant tumor. John returns back to his Canadian physician for a referral for surgery. Again, the neurosurgical consultation is estimated to take four months to occur. So John goes back to Buffalo the next week and undergoes surgery to biopsy and de-bulk the tumor. He returns to his Canadian physician with his biopsy and a request for radiation therapy. Guess what? Again there's a four-month wait list. He returns to Buffalo for the needed radiation treatment.

This story depicts the type of healthcare delays that Ted Kennedy's favorite approach will result in for Americans. Sen. Kennedy suffered the same disease as John, but not the same delay in care. Within hours of a seizure, Sen. Kennedy obtained a diagnosis and a well-organized treatment plan. In the United States, even if you aren't Sen. Kennedy-and even if you are an uninsured migrant worker-if you show up in an emergency room with a seizure, you'd receive better treatment than John did as an average Canadian citizen. I personally know that Canadian physicians are compassionate, but they are hampered by bureaucracy imposed by a national healthcare system that is, ironically, meant to address the inequalities in care between the rich and the poor. I could not practice in an environment where delays in diagnosis and treatment became accepted as a way of life.

Referring to the words of Viktor Frankel, the Austrian psychotherapist who survived the Auschwitz death camp, Dr. Adams said that in even the worst conditions of existence we can all choose our own ways. I struggle. Can we choose our own way if a system prevents choice? A single-payer, no-choice system, dictated by bureaucracy, scares me because of its lack of compassion.

I struggle still in my desire for altruistic care and my desire to provide the best care that technology can offer. I always hope I can provide both.