It is traditional at this time of the year to look back at our experiences and look forward to our opportunities. Most people do this on a personal level, and communities (including those in the medical community) do so as well. Yet, it is really hard to engage in this exercise in an unbiased manner. If we are feeling well, we may highlight the positives of 2017. If we have been disappointed, we may focus only on events that we regret. There are likely to be generational issues. Those early in their careers often find themselves tackling issues that none of us could have imagined decades ago. Those who have already made their major contributions may be grateful that these new challenges will largely be addressed without them. I grew up in an era of unbridled enthusiasm and optimism, much of it undeserved. My children are growing up in an era where options are more limited, and traditional institutions are no longer trusted. One might think that they would be horribly pessimistic about life. Yet, the emerging leaders of the future seem to be more optimistic than I would have ever imagined. The older generation may have experienced fewer impediments, but we largely ignored the problems that we had or that we created. In contrast, the younger generation sees the problems for what they are and are no longer content with sweeping them under the rug. Many are determined to repair things and make them work. There are three roles that we can play in 2018 and beyond. Some of us will look at the world as a crumbling place and will strive primarily to achieve a path of survival. They will focus on themselves: How can we endure and prosper in a world with distorted values? How can we capitalize on the weaknesses of the current system so that we will benefit? These are the takers. Others look at the challenges in the world and work to devise ways to make things better -- for everyone: How can we recreate (or create) mechanisms of trust? How can we make the world more fair and more sustainable? They will accomplish that goal by taking thousands and thousands of small positive steps. These are the doers. Still others will simply throw in the towel: emotional surrender. They think of the world as being hopeless and beyond repair, so they will neither strive to exploit it nor make it better. They will simply complain, acting as if that were somehow useful. These are the cynics. There is comfort in being cynical, but it is short-lived. To maintain a feeling of self-worth and comfort, the cynic needs to find (or invent) new targets. Otherwise, the machinery of cynicism runs out of fuel. But finding targets is not equivalent to finding solutions. When they confuse the two, cynics deceive themselves into thinking they are making a positive difference in the world. Cynics often espouse the belief that everything needs to be destroyed -- reduced to ashes -- before things can get better. That attitude allows them to avoid the responsibility and risk of proposing solutions. Yet, proposing (and perhaps trying) thousands of small solutions is the way that we will meet our current challenges. Next year I plan to use this blog to propose some unconventional (even radical) solutions. Most will be crazy and unworkable, but I hope a few may represent the beginning of a new path forward. I eagerly look forward to hearing your thoughts and reactions. The readers of this blog have made it a popular platform for the past year. And I hope that you will help me -- and MedPage Today -- make it a mechanism of change in 2018. We can all be doers. Finally, a happy, healthy and fulfilling New Year to all!