Discussion can be springboard for hypotheses, opportunities, progress

One thing I particularly appreciate about serving as Chief Medical Editor of Ophthalmology Times is the opportunity to write these columns in which your humble correspondent is allowed to raise issues that seem interesting (at least to me).

Some of you have responded to me with your comments. Sometimes the comments are positive, and sometimes they express incredulity at the nonsense I have written, or my inability to recognize the heart of the matter.

They are almost always thoughtful, insightful, well written, and do not mince words. Some have been nothing short of eloquent.

Invariably, when I get these responses, I request that the authors allow them to appear in a subsequent issue of Ophthalmology Times so that our colleagues can consider these ideas. Here's the interesting part-most often the response is something along the lines of "Oh no, I meant that only for you to see." To me, this seems a shame; we can all benefit from each other's best ideas, whether or not we agree. Although some authors agree to have their comments published under the nom de plume "name withheld upon request," this publication does not allow anonymous letters.

This reminds me of the two times I was asked to write one side of a pro-con debate for a major ophthalmic journal. Although I was pleased to do so, it took about a year in each case for the journal to find someone else to write the other side. Many prominent ophthalmologists, who believed something to be true, taught it to their students, and said it during meetings, were averse to "going on the record" in print in a debate.

This leads me to wonder why we ophthalmologists (or is it physicians or even Americans) sometimes shy away from open debate. I am told this is an increasing trend across our country, even in academic institutions, where challenging the professor is perilous.

Students are afraid that disagreement with their economics or political science professor's political views will cost them an A. Medical centers and hospitals seem to have this problem as well. Residents are afraid to challenge what the attending physician tells them, and nurses and technicians are afraid to question the doctor even if they might have good reason to do so. Is this because we are losing the ability to entertain viewpoints that, no matter how diplomatically expressed, challenge our own?

Some decry the "divided electorate" in our country. Not I.

I believe that frank discourse and clear alternatives from which voters may select help make America great. "Grand Rounds" presentations at The Wilmer Eye Institute where everyone agrees on everything are boring; give me a debate about the diagnosis, how best to treat the patient, how to handle a surgical complication, etc. Out of such discussions often come testable hypotheses and opportunities to try ways to do things better-in short, progress.

As long as people are reasonably civil and thoughtful in their comments, give me a good disagreement any day.

Being a great speaker and debater is a gift not all of us have. My father was taught to organize and present a cogent, well-expressed argument so as not to give offense. Classes in Latin, Rhetoric, and Debate (actual course titles) were part of the "classical education" of his day. Today, most of us lack such training. Even President Bush admits to being not a great extemporaneous speaker, causing some, he says, to "mis-underestimate" him.

A lack of brilliant oratorical or writing skills can be overlooked. What should not be excused, however, is vituperation. Rancor and personal attack should not cover for lack of good ideas, nor insults replace logical deliberation.

When we become unwilling to engage in frank and honest debate, we become second-class as physicians, group practices, medical societies, academic departments, universities, and countries.

Don't let Ophthalmology Times be second-class. Send us your best thoughts and the unvarnished truth as you see it, with your name attached. Space allowing, we'll print the best of it.

Sincerely yours,The Chief Medical Editor
(Name withheld upon request)

Peter J. McDonnell, MD is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times. He can be reached at 727 Maumenee Building, 600 North Wolfe St., Baltimore, MD 21287-9278. Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu