Alan Matsumoto (Charlottesville, USA) talks to Interventional News about the disruption and fragmentation that is causing a “tornado in healthcare”. He expanded on how interventional radiologists should show “unity in purpose” in the face of disaggregating forces such as consumerism, Big Business and Big Data, to centrally focus on the two things that matter most: patients who need care, and patience that allows for that care to be delivered wisely and well. Matsumoto delivered the annual Charles T Dotter Lecture at the 2019 SIR Annual Scientific Meeting (23–28 March, Austin, USA).