Privilege, Responsibility, and the Quiet Promise of Direct Care

Sadhguru once wrote, “Every privilege comes with a responsibility. If you don’t take the responsibility, you will lose the privilege.” It’s a simple line, but it cuts straight to the heart of what makes direct care work — and why it’s fragile if we’re not intentional about it.

Sadhguru isn’t talking about healthcare specifically, but the idea maps almost perfectly onto direct primary care.

Direct care is a privilege. It’s the privilege of time — longer visits, unhurried conversations, knowing patients as people instead of CPT codes. It’s the privilege of trust — patients paying directly because they believe their physician will act in their best interest. It’s the privilege of autonomy — clinicians practicing medicine without layers of bureaucracy dictating every decision.

But those privileges don’t exist in a vacuum.

They come with responsibility.

For clinicians, the responsibility is stewardship. Time must be used wisely, access must be protected, and pricing must remain honest and transparent. If direct care turns into exclusivity without accountability, or convenience without commitment, it risks losing the very trust that makes it possible.

For patients, the responsibility is participation. Direct care works best when patients engage — asking questions, respecting boundaries, and partnering in their own health rather than outsourcing all responsibility.

And for the movement as a whole, the responsibility is restraint. Just because we can market aggressively, oversell benefits, or blur lines doesn’t mean we should. The long-term privilege of practicing and expanding direct care depends on credibility, humility, and putting patients first — especially when no one is forcing us to.

Direct care isn’t guaranteed. It’s earned daily.

If we carry the responsibility seriously, the privilege endures. If we don’t, history suggests it won’t.