dr. saini to talk about that from the policymakers perspective. are the things that congress can actually do that will empower clinicians to say no, and when i say no, when we say to say no what really mean is, i think something broader than simply saying the patient who comes and says, i want knee surgery but more, the ability to say, this is what is really right for the patient despite what my hospital may need me to do and i talk in the book a little bit about the hospital putting pressure to do more procedures because that is how the hospital makes money. so for the clinician to be able to steal all the voices that are saying give more, you make more money because your hospital makes money but also in the patient comes to you. mr. cooper can talk about policy things but first i would like dr. saini to talk about clinicians because she has been doing that for a long time. >> first of all, it is a rare date that a patient says and i want x. you know the parts of being a professional is to put