• Do not walk behind me, for I may not lead. Do not walk ahead of me, for I may not follow. Do not walk beside me either. Just pretty much leave me alone.
• It's almost always darkest before dawn, so if you're going to steal your neighbor's newspaper, that's the time to do it.
• Always remember that you're unique. Just like everyone else.
• Before you criticize someone, you should walk a mile in their shoes. That way, when you criticize them, you're a mile away and you have their shoes.
• Everyone seems normal until you get to know them.
• Duct tape is like "The Force". It has a light side and a dark side, and it holds the universe together.
• Experience is something you don't get until just after you need it.
• I wondered why the baseball was getting bigger. Then it hit me.
• Did you hear about the guy whose left side was cut off? He's all right now.
• The butcher backed up into the meat grinder and got a little behind in his work.
• Show me a piano falling down a mineshaft and I'll show you A-flat miner.

For those of you thinking this musing was about marital intimacy or increasing your libido you'll be disappointed; rather my focus is on how to keep the practice of medicine fun for a lifetime. What determines whether medicine is a dull habit or an exciting adventure?

I've heard it all "the golden age of medicine is over, I can't wait to retire, If I could afford it I would retire tomorrow, I wouldn't want my child to go into medicine, Its no fun anymore, The doctor/patient relationship is dead, The paperwork is overwhelming, Dealing with insurance and Medicare is not worth it, Patients are too demanding and litigious."

Many physicians after years of clinical practice seem to no longer enjoy much of what they do. They appreciate their incomes and social status and independence but resent much of the day-to-day demands from patients. Only rarely do they seem to get excited about challenging cases. Their reading becomes perfunctory. They seldom are seen at CME activities. Their altruism atrophies and they often become mere skilled technicians.

What satisfactions are there which will carry us for the long haul? Although I do not underestimate the economic rewards of medicine I believe there are other more personal rewards as compelling.

Few physicians fail to get immense satisfaction from helping people who are suffering and in pain. Good doctors truly may make a difference in patient's lives.

Don't fall prey to the business ethic that has so over taken medicine at the expense of the fundamental ethos which calls for us to put the welfare of our patients above our own self interest.

Give back in full measure to society by passing on your knowledge to the next generation of physicians by teaching and volunteering. It is often noted that the word doctor means teacher but less appreciated is that as teacher of himself through reading and CME activities he meets this challenge most effectively. Complacency is the dry rot of medical competence. Perhaps the greatest compassion is making the correct diagnosis.

Get to know your patients not as customers, clients, or strangers but as human beings with dignity and value. Share your humaneness with them. We exist after all because of patients not visa versa. They come to us because they have a problem. We must elbow our way past the bewildering array of technology back to the bedside. "The secret of the care of the patient is in caring for the patient." Francis Peabody

John J. Mohr, M.D.