• Gardening Rule: When weeding, the best way to make sure you are removing a week and not a valuable plant is pull on it. If it comes out of the ground easily, it is a valuable plant.
• Who was the first person to look at a cow and say, "I think I'll squeeze these dangly things here, and drink whatever comes out?"
• Who was the first person to say, "See that chicken there? I'm gonna eat the next thing that comes outta its butt."
• Why does Goofy stand erect while Pluto remains on all fours?
• If Wile E. Coyote had enough money to buy all that Acme crap, why didn't he just buy dinner?
• Do illiterate people get the full effect of Alphabet soup?
• Did you ever notice that when you blow in a dog's face, he gets mad at you, but when you take him on a car ride, he sticks his head out the window?
• Does pushing the elevator button more than once make it arrive faster?

What ever happened to "word of mouth"? Time was when physicians grew or sustained their practices by gaining a reputation of competent quality care. Now more than ever many are following the trend of the business world by aggressively advertising (marketing) their services. Through the use of television, the internet, radio, and print media physicians now more than ever market their services. Many hire professional marketing consultants. These advertisements go far beyond merely informing the patients of available services. They often include promises of discounts, guarantees, or gifts. Some use increasingly slick techniques which lure and coax or scare people to use their services. Expensive and new technologies are often over emphasized and risks are rarely mentioned. Many of these techniques can only be described as crassly commercial. In the past local medical societies would have frowned at such behavior but now are sponsors of programs touted to show physicians how to market their "product line".

To a large extent physicians today are perceived by the public as highly successful business people functioning with a business ethic. To some this is as it should be, believing that physicians have a knowledge base and skill to market hence have become mere technicians. Many physicians are perplexed as to how they should react when caught up in the web of economic and business decisions in medicine. The profession no longer agrees on universal moral principles.

Perhaps "word of mouth" is no longer sufficient to build a viable practice in medicine. But if the practice of medicine simply becomes a profit making business instead of that sacred covenant between physician and patient we will have forfeited our claim to the high position our profession has enjoyed. Implicit in the question, "How may I help?" is the physician's obligation to place the patient's interests above their own. To abuse this trust invites further corrosion of our profession.

John J. Mohr, M.D.