October 01, 2003

A Profession of Clamoring Scum and Anonymous Splendor

by Mark Johnson, M.D., F.A.C.S.

To be a professional is different from just having a job or even from doing your job well. This distinction has been lost and blurred during recent decades. Workers want to claim to be professionals, as a mark of excellence and ability.

Professionals want to claim to be no more than businessmen and capitalists, and escape obligation to standards and goals more lofty than the pursuit of the almighty American dollar.

The classic professions: Law, medicine, and the clergy were and are in essence outside of the mercantile/business world. The most critical distinction between commerce and a profession is in the fundamental purpose of the endeavor.

A profession is first a service of caring for others. Professionals are required to put the well being of their clients above all else, including their own financial gain and potential loss of personal well being. They are expected to have mastered a specific, difficult, and arcane body of knowledge and skills. Their expertise is certified by, regulated, and subject to oversight by professional boards of fellow experts.

The traditional place and respect for members of the profession of medicine within society has been very high. People have admired these professionals because they adhered to those high and challenging standards.

Physicians were admired because they spent hard years in hard training, because they put themselves into harm’s way, risking plague and death themselves to minister good toward their patients. Doctors were admired because they traveled through blizzards to deliver babies, answered the call in the night and on weekends, because they staffed the wards of contagious disease clinics, because they peacefully came under fire while caring for the wounded in wartime, and because they faced levels of misery, anguish, and physical degradation that were beyond the bearing of many ordinary persons.

Ophthalmology is in a time of seeming betrayal of its professionalism. There is a great and successful effort by a noisy and prominent group of physicians to cherry-pick their professional status. They want the admiration, status, and money that the profession delivers, but they do not want to meet and adhere to the obligations as well.

It’s good to be a doctor when medicine offers a prestigious title, six-figure wealth, a remarkable degree of autonomy, and astounding degrees of power within offices, in hospitals, over fellow members of ancillary professions, and upon the lives and well-being of our patients.

These same “professionals” complain endlessly when society demands they respond to the needs of patients in emergency rooms, answer for the outcomes of their actions in malpractice courts and before medical boards, or justify through review the expenses they incur for third-party payers.

Like spoiled teenagers, they want all the privileges of society, but none of the obligations.

Ophthalmology has been helped and hurried upon the road to professional damnation. Courts of law have defined the practice of medicine as commerce, and prevented societies and boards from important areas of self-regulation. No standard of acceptable and professional advertising can be defined, and so the most vulgar and avaricious members of our profession set the standards our patients see in newspapers, on billboards, and on radio and television.

There can be no peer review in the present world without the danger of litigation, so we become afraid to point out the misbehavior of our fellows. Practice consultants ride into town like villainous plague-carriers, spreading the most greedy and lewd latest methods to attract patients, sell services, degrade our peers, and squeeze even more money out of our patient populations.

Throwaway journals seem devoted to making titans of the most avaricious and self-aggrandizing members of our profession. Each physician jostles forward, trying to be the loudest rooster to crow its own glory.

From “My 100,000-thousand-dollar day,” to “My newest instrument named after me,” to “How I see 200 patients a day” to the “My surgical institute,” to “Two-minute surgeries,” to the “Newest and greatest and best machine/medicine (that I have stock in) in the world,” to “How I advertised and billed my way to my first million dollars!”

The parade of hucksters and snake-oil dealers is seemingly endless. Please understand, I don’t envy you your wealth and fame. I merely despise the fact that people might mistake me for your peer.

Yet the fact is, like scum on water, this population of villains comprises only a tiny, yet exceedingly overexposed percentage of our profession. Thousands of honest, ethical, and well-intentioned ophthalmologists toil admirably on, in anonymous splendor.

They are competent, they are compassionate, and they place patient-good above all concerns. They doubt themselves, as they face this Wicked-Witch Mirror of our profession held up by throwaways, advertising, and the media. Alone in their offices, they wonder if they are odd, if they have missed the boat, if they too should be consumed with making millions and getting instruments named after themselves.


We all know what is right for our profession. It is right to care more about patients than making them into a source of personal wealth. It is right to see no more patients, and do surgery on no more patients than we can take good personal care of. Good, good, care.

Don’t cut corners in the office, in the OR, or in the emergency room. It is right to portray our education, expertise, services, and technology without excessive self-aggrandizement. Don’t cheat, over-bill, up-code, or be dishonest. Be careful with new innovations and techniques, as the patient will suffer the harm if we do poorly.

Don’t vilify your peers without cause, help them if you can to take as good of care of their patients as you do yours. Work together. Share. Don’t treat your staff as lightning rods to absorb your indulgent excesses of anger, cruelty, greediness, or lust.

Serve principles and goals more admirable than the satiation of greed and sensation.

Dilate your complete exams.

There is this profession: There is the scum. There is the water. Be the clear, clean water.

We have this extraordinary profession. Today and every day you choose: Scum or bright water. Be the clear, clean water.

About the Physician
Mark Johnson M.D., F.A.C.S., is in private practice, Venice, Fla. Contact him at 941-480-0600, fax 941-485-8090, onebluetree@netscape.net.



Posted by Admin at October 1, 2003 02:05 AM