In 1993, the New England Journal of Medicine published Dr. Sweet’s whimsical graph which showed that if present trends continued, by 2026 there would two million administrators in US hospitals, and no patients. For the graph, see Dr. Sweet’s letter on page 1655. Those trends did continue and even spread outside the hospital, to the clinic, the private practice, and any place where doctors and patients try to meet. The amount of money spent on regulating and administering regulations in healthcare has skyrocketed, at the ironic cost of the time doctors and patients can spend together.

Now, what with all of the efficiencies built into our newly reconstructed healthcare system, most doctors no longer have the time—often one or two hours—to spend going into depth around a complicated case, or with a patient worried that his real diagnosis has not been found, or her deep concerns not addressed.

The Second Opinion Clinic is a more practical, more modest version of the Ecomedicine Project; it is simply a place where patients can come for a second opinion. It will start as a pilot project at the New Laguna Honda, using the ways of the Old Laguna Honda.

Its hypothesis is that what is most efficient for healthcare is not more computerized data tracking, deskilling, forms, regulations and directives, but, simply, more doctor time. Like the Ecomedicine Project, it will track costs—mostly more doctor time—against savings—from X-rays and laboratory tests not ordered to unnecessary medications discontinued and incorrect diagnoses deleted.