Some years ago, the Academy launched its Eye M.D. campaign. To paraphrase this slogan, I ask: Why M.D.? We are all here because we wanted to be doctors. Almost without thinking, we entered the process of becoming physicians. This process involved hard work, good luck and the support of many. We pledged to do what was best for our patients. We took the Hippocratic oath and assumed responsibilities consistent with any profession.
Our rewards have been obvious. Can anyone imagine a more wonderful vocation than helping people see?
Why, then, is there dis-ease among us?
Sometimes, it helps to see how others view us. Sociologist Elliott Krause, in his book Death of the Guilds, analyzes why professions—including medicine —have fallen from their prestigious positions.1 He recounts the craft guilds’ glory days of the 15th and 16th centuries. In large part, members were proceduralists: They crafted candles, shoed horses, and filled other basic societal needs. They had power, control and income. This ended because forces from outside the guilds saw potential for material gain, and alternative ways were found to fill a need. From within, guild members trained less-educated people to perform skills. The only guild to survive was the “academic” guild, where knowledge distinguished its participants from pretenders.
Krause concludes with a lament for you and me—as well as the rest of society—by asking: “Who can stop this irresistible tide?”
I believe you and I can! First, let’s look at lessons from centuries ago. The survivor guild had knowledge as its core ingredient. The losers, Krause said, demonstrated behavior of greed, arrogance and a willingness to downplay skills and transfer them to others.
Without a doubt, knowledge is on our side. The depth of our training ensures that we have the tools to care for our patients. I would propose that there are at least four essential behaviors each of us can adopt to stop the “irresistible” tide.
1. We must maintain our ties to medicine. What’s new in diabetes that could help us provide better care? What does AMD have in common with other aging processes? How do we turn brain plasticity on or off?
2. We must maintain our own competence. What do our CME credits over the past year reflect? When did we last attend grand rounds? What have we learned about the public outcry over medical error, or the need to communicate more effectively?
3. We must involve ourselves with our medical community. In the mid-’70s, more than 25 percent of hospital beds were for eye patients. Ward rounds are now nonexistent, but ERs, ICUs, NICUs, and even medical staff committees still need us.
4. We must train tomorrow’s ophthalmologists. Ophthalmology continues to attract bright people. Adopt a resident! Their enthusiasm is contagious. They remind us of why we chose to be ophthalmologists, push us to learn new approaches, and serve patients who otherwise might not receive care.
Why M.D.? It is the process of our education that makes us what we are. We have the knowledge it takes to serve society. Now, our behavior will determine our future.
1 Krause, E. Death of the Guilds (New Haven: Yale University Press, 1996).