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As a cardiologist, I see a medical world that is at once exciting and challenging. The excitement comes as scientific and technological research continues to answer important questions and give us solutions to our patient problems. Challenges come in the form of a fragmented health care system that is economically strained. While much of heart disease is genetically determined, there is a strong environmental impact. This is the old Nature vs. Nurture controversy. It plays out in the field of cardiology as well. While some disorders have a pure genetic basis, most diseases develop as a result of interaction between our genetics and our environment. This means that we have some control over our destiny. We can choose to not smoke, to drink in moderation, to exercise and to make dietary choices that promote health. I tell all of my patients who have or are at risk for heart disease that exercise and nutrition have as much impact as many of the medications that we prescribe. I view my relationship with patients as a partnership. There are things you can do to help me deliver better care to you. Being organized and prepared for your office visits is extremely important. Bring a list of questions, bring a list of your medications, bring an updated health history if there have been changes between visits. Know what medications need to be refilled. If your history is complex, type it up and update it as needed. This will help all doctors that you may need to see.