A FIRST BRUSH WITH PROFESSIONAL COURTESY

Some time ago, a colleague showed me a letter from the new financial manager of a distinguished
academic hospital where he had served as a housestaff officer. All alumni were warned that giving
special assistance to fellow physicians or their families, sometimes called professional courtesy,
could be too costly in these times of health care penury.

I always thought that the injunction of the Hippocratic Oath "to consider dear to me as my parents
him who taught me this art" was a good lesson in kindness to be shown to those who practiced my
"art" and their families. I shared my colleague's indignation and, as I considered the matter,
remembered my first brush with professional courtesy.

I became a medical student 60 years ago. Unusual circumstances occasioned more by World War II
than any special talents of mine propelled me to medical school at an early age. I was very
frightened by the prospect of undertaking so arduous a study far from home.

Adding to my fears was the worry that some unpleasant episodes of nausea and the sensation of a
lump in the pit of my stomach were the beginnings of a bad illness. My older brother insisted that I
visit our family physician, and he even gave me the $2.00 fee.

A few days later, burly and sometimes gruff Dr. S. was greeted by my "Guess what? I've been
accepted to medical school." I interrupted his happy smile and handshake with the further news
that I couldn't accept the offer because of my illness and, in a hoarse whisper, I even suggested
the dreaded diagnosis: "Cancer."

He asked for all the details ("When did it begin? What else hurt?") as he felt my abdomen. When I
pulled up my trousers and sat before his great desk, adjacent to the examining room, I was given
his opinion: "I don't think you have cancer. But let me tell you something. If I thought I had cancer,
I wouldn't be sitting here talking to an ordinary family doctor. I would get to that medical school as
fast as I could. The people in medical schools these days know what to do with all kinds of
illnesses. They'll take the best care of you and fix you up while you are doing your studies."

As we walked slowly from his office, I was not at all certain what my next step would be. He
opened the door and I reached into my pocket to give him the $2.00 fee. It was promptly refused:
"No, no, my boy, professional courtesy, you know." He put his arm around my shoulder and
walked me all the way down the porch steps of the old Victorian house, both home and office,
with a farewell: "I know all about medical school you'll do just fine."

I began to feel less tense. The symptoms disappeared as I attended to leaving college, getting a
train ticket, and packing. Some months later when I had my first examination in anatomy, there
was a faint flicker of that lumpy sensation in the pit of my stomach, but thereafter it completely
disappeared.
Dr. S.'s diagnosis of 60 years ago, made without gastroscopy or GI series, must have been correct.
Since then I have never forgotten his kindness and the power of reassurance. His "professional
courtesy" put me on the right path.

Perhaps treating fellow physicians for no fee is no longer possible, but for many years it was
proper behavior. In 1966, it was American Medical Association policy that "a physician should
cheerfully and without recompense give his professional services to physicians or their
dependents."

By 1997, it became that "(physicians should use their own judgment in deciding whether to waive
or reduce their fees when treating fellow physicians or their families." It wasn't the $2.00 saved
that made my incident so memorable) the hand that refused the fee was the one that gave me a
reassuring pat and bade me enter the profession.

I believe such warmth is the aspect of professional courtesy that should always flourish. Friendship
and concern for our colleagues and their families are the expression of our gratitude for being one
of this band of brothers (and sisters).

Control questions

1. ¿Have you heard about the Hippocratic oath?

2. ¿What motivated him to study medicine?

3. ¿Was there something or someone for whom you want to be a health professional?

4. ¿Do you think that what the guide talks about does not apply today?