He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

Peter J. McDonnell, MD

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When I was a young assistant professor (yes, that was a long, long time ago!), I usually operated on Fridays and came in on Saturdays to see my postoperative patients and any patients with corneal ulcers or other problems needing close follow-up.  

Often my 3 young children would play or crawl around on the floor of my office while I did my work.

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One day I was seeing one of my postoperative patients who was a very successful businessperson about the age I am now. He was the archetype of the high-powered CEO and a friend of the president of my university. 

Happily, he had a perfect result, and after reviewing with him the postoperative medication regimen, I asked him if he had any questions.

“Yes,” he said, “do you always work on Saturdays?” I told him that I did.

“So, do you work 6 days a week?” he asked, and I confirmed this was the case—unless something urgent, like a perforated corneal ulcer, came in over the weekend requiring me to come in to glue a perforation or do surgery on Sunday.

“Would you mind if an old man offered you some advice?” he asked me. I encouraged him to share his thoughts.

“You have these 3 beautiful children,” he said. “They are young now, but they will grow up seemingly overnight and be gone. When I was young like you, I worked 6 or 7 days per week building my business and worried about making enough money to provide security for my family. As a result, I did not spend the time with my children that I now wish I had. Now they are grown, busy with their work and families, and do not have much time for me. Meanwhile, I am left with more money than I need. Maybe you could dial back on your career a bit.”

I thanked him for his advice, knowing it was motivated by the best of intentions. I remember thinking that I had heard this plenty of times from older men. 

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Little did these older folks appreciate the cost of living in Southern California or the rapidly increasing college tuition bills for the children of young parents like me. 

Not to mention the fact that in academics, you either publish or perish and traveling to the major meetings is pretty much mandatory if you want to be taken seriously on the national or international stage.

“These older fellows do not understand the pressures on today’s young professionals who are parents,” I thought.

It has been 30 years, and I remember this conversation as if it were yesterday. 

Yes, Southern California real estate was (and remains) very expensive, but every physician can afford a decent home. And yes, college and professional school tuitions are ridiculously expensive and continue to rise quickly. 

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But I and all my doctor friends have handled those bills as well, and today we all seem to have more funds than we really need. 

And now my children—like those of my patient—are grown, busy, and living in other cities.

Because humans like me really do “live forward but [only come to] understand backwards,” today I believe my youth and inexperience prevented me from fully appreciating the wisdom in the words of the fathers who were a generation or two ahead of me. 

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Living forward:  We still have to understand backward


Born in Ohio in 1822, Hiram Ulysses Grant went on to lead the Union Army to victory during the American Civil War. A national hero, he became the 18th president of the United States. 

During his time in office, he created the Justice Department and used it to aggressively suppress the Ku Klux Klan.

Almost famous: Ophthalmologist gained worldwide attention in 1910

William Halsey Jr, born in New Jersey in 1882, became the second-highest ranking American naval officer in the Pacific in World War II. 

Described as “flamboyant, vulgar, aggressive, and spectacularly ugly,” the admiral was loved by his troops. 

An intelligence officer described the reaction to the news that Admiral Halsey had been ordered to take command during the Guadalcanal campaign: 

“One minute, we were too limp with malaria to crawl out of our foxholes. The next, we were running around, whooping like kids.”

Halsey’s leadership is credited with turning impending defeat into a major Allied victory. He was decorated with the Navy Cross, the Navy Distinguished Service Medal, and the Army Distinguished Service Medal.

Joe Jamail Jr, born in Texas in 1925, served in the US Marine Corps for over 2 years in the Pacific in World War II before becoming an attorney. 

He became known as the “King of Torts” in recognition of his victories against large corporations, winning more than 200 verdicts, or settlements, of at least $1 million. 

Living forward: We still have to understand backward

 proclaimed him the nation’s richest practicing lawyer, and 

 magazine estimated his net worth at $1.65 billion.

Aside from military service, what do these 3 gentlemen have in common? 

The common thread that strikes me is that all 3—while enrolled in the schools that would prepare them for their subsequent meteoric careers—were considered mediocre by their professors. 

At West Point Military, Grant proved himself a talented horseman, but ranked in the bottom half of the class, which prevented him from qualifying for a position in the cavalry upon graduation. 

Halsey proved himself a talented athlete at the US Naval Academy in Annapolis, Maryland, but graduated in the bottom third of his class. And as a law student at the University of Texas at Austin, Jamail’s professor flunked him in the class on torts.

How could their professors have failed to recognize the future superstars they would become? 

Are the traits that allow doing well in class so different from those that predict 

Do our professors value the wrong things? 

Or is it the case that these young men matured and blossomed later in life, finally focusing on what was needed to rise to the top of their respective professions?

I wonder about this when it comes to how we train our young physicians and surgeons. 

In your residency, did your faculty emphasize the right things? Did they recognize your future promise?

Do grades predict performance?


A body is discovered buried in the cellar of a London home. The head, hands and all the bones had been dissected away, leaving only the organs and soft tissues. 

Needless to say, in 1910 there was no ability to confirm identity with DNA. 

The disappearance of the husband, in the company of his secretary/girlfriend Ethel Le Neve, naturally made him the leading suspect, but he eluded the authorities, escaped from England and seemingly had disappeared.

The suspect, Hawley Harvey Crippen, an American, decided to travel by ship from his hiding place on the European continent back to the United States. Ethel, her hair cut short, pretended to be his son. 

Unfortunately for the abscondees, the ship’s captain saw through their disguises. 

And also unfortunately, the ship was one of a relatively small number of vessels equipped with the recent technology developed by Guglielmo Marconi known as wireless telegraphy. 

The captain messaged his observations back to London, resulting in a Scotland Yard detective immediately setting sail on a newer and faster ship in order to apprehend the suspects before they could vanish into the giant North American continent.

Worldwide attention focused on the flight of the couple, the effort to capture them and the role of the new technology of the earliest radio devices. 

Front pages of newspapers around the world included daily updates, with locations of the ships and observations about the fugitives.

Crippen was arrested by the Scotland Yard detective, returned to England, and promptly tried for murder.



Although he maintained his innocence, the jury deliberated for less than half an hour before finding him guilty. Three weeks later he was hanged.

I've heard of the case, but what I had not known before reading 

was that Crippen was a U.S.-trained physician, and not only a physician but an ophthalmologist! 

He attended medical school at the Cleveland Homeopathic Hospital (homeopathy was very popular in the United States around the 1880s) and then moved to study “ocular medicine” at the New York Ophthalmic Hospital at Third Avenue and 23rd Street, graduating in 1887. 

In his murder trial, prosecutors argued that his medical training gave the defendant access to poisons such as henbane (then commonly used in ophthalmic treatments) and conjectured that he had administered such a drug to his wife before dissecting her corpse. Cora Crippen was the victim. 

Author Erik Larson makes clear she was an egotistical unsympathetic character who was emotionally abusive and probably unfaithful to her husband. 

Some readers may take pride in knowing an ophthalmologist briefly became the most talked about man in the world, taking the view that all publicity is good publicity. 

But while a lot of things may have changed in terms of societal mores in the past 111 years, and while the American Academy of Ophthalmology’s Code of Ethics does not explicitly condemn it, I hope we can all agree that ophthalmologists should refrain from murdering their spouses, children (including teenagers!) and even in-laws.

A word from Chief Medical Editor Peter J. McDonnell, MD. 


After a recent lecture by a young medical student delivered via Zoom, I watched as an audience member asked a question about the interesting work described in her presentation. 

The student responded with “That is a great question!” before giving her answer.

A second audience member asked a question and the response was once again prefaced by “That is a great question!” 

When questions 3, 4 and 5 were raised, the answers began with – you guessed it, “that is a great question!”

Luckily, this was not one of those drinking games during which everyone has to consume alcohol each time a certain word or phrase is used. 

If it had been, we would have quickly become insensible.


Apparently, we Americans employ this rhetorical device much more frequently than is the case in other English-speaking nations.

Speakers want the person asking the question to feel good. They are telling them “I think you are intelligent.”

The speakers wants a few seconds to think about their answer before they respond and, rather than have a moment of quiet that might seem awkward they feel better with having their mouths say the 4 words while their brains think about things.

Speakers want to be liked, so they throw out the compliment as a way to endear themselves to the audience.

According to at least 1 public speaker authority, the phrase can be used as a “bridge,” which is a device by which the speaker tries to make a transition to a somewhat different topic. 
Politicians, of course, are experts at this, such as when they do not answer the question they were asked and instead talk about what they want to talk about (i.e. their so-called talking points). 

To me, this is the opposite of explanation #1, because the speaker is communicating that “I think you are so stupid that all I have to do is praise your question to make you not care that I refuse to answer it.”

It seems to me that routine use of this expression has its potential drawbacks:

What if an audience member asks a question and the speaker’s brain forgets to include the obligatory “that is a great question!”

Will the audience member be offended, interpreting the lack of praise for his or her question as the equivalent of the speaker saying “what a stupid question!”?

When a speaker does it routinely, it quickly becomes a kind of a joke for the audience members who find themselves waiting eagerly to hear it time and time again.

My recommendation is that speakers at least make an effort to change things up a bit, so that they compliment the questioner without sounding silly and achieve whatever other goals they might in buying a few seconds to think. 

What a shrewd and discerning disquisition!

Will one day we be able to put an end to the overuse of this phrase? 

That is a great question! 



That’s a Great Question! (Ep. 192). January 15, 2015; Accessed June 14, 2021. https://freakonomics.com/podcast/thats-a-great-question-a-new-freakonomics-radio-podcast/

Looking for potential substitutes to a frequently overused response.

Peter J. McDonnell, MD

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Almost famous: Ophthalmologist gained worldwide attention in 1910

'A great question'

Living forward: We still have to understand backward