Everywhere You look in society today, particularly when you focus on consumer-oriented issues, the trends stress the rise of the individual. Not satisfied to choose from the 300-plus channels available on satellite and cable? You can create your own TV programming on your own schedule. You don't want to endure an entire album? Download the songs you do want, and enjoy your own album  walled off in your iPod world. In fact, if you don't like the way a particular song on your album was mastered, remix it to your own taste. And, by the way, if the taste that new mix leaves isn't to your liking, just pull down one of the 85—yes, 85—varieties of Crest toothpaste and brush it away.

In medicine, the trend has thus far been confined to the paying customer (if you insist, patient). Plastic surgery has always been about tailoring care to the individual, or indeed, tailoring the individual. In ophthalmology, custom ablation manifests the trend. The ultimate expression in medicine, however, will be enabled by genetics.

As evidence that the day may be closer than we realize, the FDA this week issued a guidance to drug manufacturers on the procedures that it will follow regarding new medical products developed through the science of pharmacogenomics, which allows health-care providers to identify sources of an individual's profile of drug response and predict the best possible treatment option for that individual. "Instead of the standard hit-or-miss approach to treating patients, where it can take multiple attempts to find the right drug and the right dose, doctors will eventually be able to analyze a patient's genetic profile and prescribe the best available drug therapy and dose from the start," the agency says.

I hope I live to see it. Wide doesn't begin to describe the gulf that exists between that ideal and the reality of today's health-care financing.

Individuality has a price, and a high one. We have miles to go before we resolve how this trend toward individualized care will play out in a medical system that is built to treat the masses.

But everyday, more and more patients walk through the doors of your practice, used to treatment in other areas of their lives that says they're the king, and their needs and wants will be met on demand. The ability to deliver in medicine may not be there yet. But the expectations are already well-entrenched.