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Dr. Keohane discusses the importance of the medical center to Duke University; the future importance of the medical center to Richard Brodhead as president; Keohane's view of the medical center as president of Duke University; crises in medical care due to managed care; Dr. Ralph Snyderman; Dr. Dan Tosteson; Jerome Grossman; reappointment of Dr. Ralph Snyderman; Dr. Bill Anylan; Dr. H. Keith H. Brodie; Bill Donelan; Fuqua School of Business; decentralized nature of medical center and university; need for more centralization; creation of the health system; health system in relationship to Duke as a whole; Private Diagnostic Clinics; personal constituencies; John Burness; Ad Hoc Governance Committee; Board of Trustees; committee's recommendations for clarification of the nature of the health system; Dr. Victor Dzau; Doris Duke; Dr. Wilburt Davison's relationship with Doris Duke; Mary Duke Biddle Trent Semans; African Americans at the Medical Center; Jean Spaulding; Duke-Durham Neighborhood Partnership Initiative; MaryAnn Black; School of Nursing; Thelma Ingles; nature of Dr. Walter Campbell's book; organizational issues and political nature of Duke University Medical Center's organization; acquisitions and divestments of the Medical Center during managed care; vision of medical center during managed care; economic purpose behind divestments; WellPath; translational medicine; personal views of Dr. Ralph Snyderman's leadership.