The author, a seasoned midcareer family physician, summarizes his personal practice philosophy as it relates to encounters with patients. By focusing on 3 aspects of care--process issues, people issues, and political issues--he explores the unique characteristics of his clinical decision-making process. He concludes by noting that it is through examination of the question "How do I think in the work I do?" that family physicians can best bring their signature presences to their encounters with patients and their families.