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October 2008

Entitlement: Do You Feel You Deserve It?
By Richard P. Mills, MD, MPH, Chief Medical Editor, EyeNet

The other day in the supermarket checkout line, the youth in front of me was waiting for the debit card verification on an 80-cent candy bar purchase. Thus, I had time to scan the covers of the celebrity-focused magazines in the racks to my right. I wondered what caused the featured people to have such mounds of cumulative trouble in their lives. I thought of the similarities to today’s professional athletes, who seem to have a disproportionate share of criminal justice challenges compared with ordinary citizens. Must be their wealth, I thought sanctimoniously, must be too much time on their hands, freed up by not having to worry about gas prices. Well, no, wealth and free time don’t explain the backroom antics of politicians (or at least some politicians). So maybe it’s the power. Power and wealth, I concluded.

Back in the car on the way home, I started poking holes in my theory. What about several beautiful women and handsome men I have known, neither wealthy nor powerful, who thought they had license to disregard the feelings of others in their quest for self-fulfillment? And what about some of my colleague ophthalmologists who fail to embrace professionalism in their everyday practice lives, who somehow don’t understand that the ethical rules apply to them? Then it dawned on me: A sense of entitlement is the common thread connecting the celebrities, pro athletes, politicians, beautiful people and doctors. In each case, they are continually receiving unsolicited offers from people wishing to curry their favor.

These offers are proffered because of the status or standing of the individual, not because of any particular merit or worth the individual provides. In some cases, the offers might be financial, in others gifts, and in still others rapturous praise. What is pernicious about multiple unsolicited offers is that before long the recipients start to think they deserve the offers, and after that, they begin to expect them (though still unsolicited). That’s when the sense of entitlement takes over the psyche and its hobgoblin arrogance materializes as a part of ordinary life.

Physicians are especially prone to feeling entitled. They point out that they worked hard and accumulated massive student debt to earn the MD degree. They are spending their lives in the service of society caring for the sick and infirm, all the while watching as their compensation fails to keep pace with their expenses. Isn’t it true, they argue, that society owes them something? The trouble is, society isn’t giving back in a material sense. Instead, a few grateful patients may bring presents to the office, from free fruit from the backyard orchard to gaily wrapped artwork of the patient’s creation. And then, there are the drug and device reps, eager to cement friendships to encourage a prescription or a sale.

Ordinarily, a buyer might be armed with a caveat emptor attitude toward salesmen bearing gifts. As consumers, we’ve all been taught to deal with that. It’s even more important for a professional to be skeptical since he or she is acting on behalf of patients. But any sense of entitlement carried by the physician tends to impair awareness of the true motivations of the transaction, and in so doing, cripples his or her ability to react professionally.

So when a patient whom I’ve just met starts to go on and on about my reputation, or when I get a free gift from a vendor company, I’m going to try to reject my sense of entitlement and retain my skepticism and the well-being of my professionalism.