Correspondence

Professionalism

N Engl J Med 1998; 338:66January 1, 1998

Article

To the Editor:

Karen Ignagni, the president of the American Association of Health Plans, stated in the October 9 issue, “The editor of the New England Journal of Medicine is entitled to be a critic of managed care, but it is profoundly disturbing to see such an important and presumably dispassionate publication used as a sounding board for these critical views.”1 That managed care promotes the slogan “Putting patients first” says it all. That is the unspoken assumption of the medical profession. It has been the foundation of the physician–patient relationship since Hippocrates. This special relationship is based on honor, and honor need not be spoken. Doctors do not require a slogan for trust. When trust is gone, it cannot be restored, like a soul that has left the body. Trust that is honored cannot be captured by a managed-care contract. Grasp a butterfly with hot tongs and the butterfly dies.

What physician, including the editor, can be dispassionate about the current destruction of our medical family at the hands of profit-hungry CEOs? Putting profit first is their unspoken assumption. As a practicing neurosurgeon for 28 years, I recommend passion when compassion for the patient is first, foremost, and central. As a young resident, I remember Wilder Penfield's words: “Keep the businessman out of medicine.” I challenge you, as editor, to continue to speak in strong terms about the heart of the matter. In medicine we are witnesses to, and to some extent accomplices in, the social revolution aimed at converting people into integers. As Osler said, we can have both, science and faith, if only we keep them separate. There is plenty of room for dispassionate science in the Journal, but honor, trust, and dignity are matters of faith, not science. Once we were knights, duty bound to protect each and every patient, regardless of monetary concerns.

We physicians have allowed the current gross decline in our once noble profession. We have been passive passengers, docile slaves obedient to the gag clause. We cannot rely on government or the profit-oriented insurance industry to correct the medical train wreck in progress. We must take over the engine. We must lift ourselves up, with passion.

Charles W. Needham, M.D.
5 Elmcrest Terr., Norwalk, CT 06850

1 References

1
Ignagni K. Putting patients first? N Engl J Med 1997;337:1084-1084
Full Text | Web of Science | Medline

To the Editor:

You point out how the fee-for-service system participates in the support of research and education.1 You omit, however, an important aspect of that support: the countless hours that voluntary clinical faculty contribute as ward attendings, clinic attendings, and preceptors in their own offices. These physicians are culled from any area where there is a medical school (and often where there is not). They give willingly and generously of their time and expertise, believing that being a physician includes passing along their hard-won knowledge and skills to the next generation. Many of my colleagues and I have been preceptors and attending physicians year after year, for countless young medical students and physicians. We do this silently and without fanfare. Most of the general public does not even know about it, as witnessed by the reactions of my new patients (the old ones are used to it), who are surprised and usually delighted to see students in the office.

Pepi Granat, M.D.
7800 Red Rd., South Miami, FL 33143

1 References