First a little inspiration in the form of a letter to the editor to the:

The New England Journal of Medicine -- January 1, 1998 -- Volume 338, Number 1

Professionalism

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

Onward ......