O'Day's editorial1 regarding the new clinical practice guidelines on cataract management published by the Agency for Health Care Policy and Research is a harbinger of a new era in medical care. For centuries, physicians have considered themselves a class of professionals above observing the basic tenets of good business and marketing. Ophthalmologists, in their rush to provide what they consider the standard of care, have perfected the use of ancillary tests and statistics to convince patients with early visual alterations due to cataracts that they need surgery imminently. In an environment in which health care costs are rising much faster than inflation and many citizens are underinsured, it is definitely time that the old practices be reconsidered.
Japanese industrial leaders and the more successful American entrepreneurs have discovered that there is only one measure that will guarantee survival against tough competition: putting the customer first.2 This is