As I See It

Between Town and Gown

We need experts, but not those who would use their academic credentials to do battle against us.

By Paul S. Koch, M.D. Editor Emeritus

Twenty-seven years ago, I decided to set up shop in a suburb of Providence, and later decided to limit myself to one or two procedures. There's an awful lot of ophthalmology that I no longer do, know, remember or care about. I have associates, colleagues and consultants whose expertise I can tap if I need to. Some of them are very interesting people who decided to limit themselves even more narrowly than I, specializing in genetics, or pediatric uveitis or ophthalmic parasitology. We call them academics.

Some academics join us working stiffs, grinding out one patient after another, earning a living as a well-paid piece worker. Others choose to spend the day reading the literature, writing it, rounding with residents, holding court and pontificating. God bless them, too. To every need there is a season.

When the Bond Breaks

However, either I am slow on the uptake or this is a more recent phenomenon, but I see deterioration in the historic bond between the town and gown practitioners. When I have a problem, I'm relieved that there's an academic nearby to give me a hand. When I recently had a LASIK patient with an infection that would not die, I'm glad I had a friend who figured out the patient's bug, found the best treatment (Bactrim) and cured him. Unfortunately, on another occasion I unwisely requested help from a different academic whom I did not realize routinely told referred patients the "If you had only come here first…" cowdoodie. When I realized it, I cut him off and told many friends why.

However, I wear another hat, one that rests on the balding head of one who occasionally reviews cases potentially heading to trial. In recent years I believe every single one (I may have forgotten the lone exception) that I reviewed had a so-called expert who is affiliated with one of three places: an august ophthalmic institution located in a city in Eastern New England, an august ophthalmic institution located in a mid-Atlantic state or a major medical center located near the Rock and Roll Hall of Fame.

So-Called Experts

Typically, these so-called experts do not practice in the area in contention. If the case concerns cataract surgery, the experts may not actually do anterior segment surgery, but claim to counsel cataract patients every day in their consultative practice, leaving me to wonder why so many cataract patients pour in for an evaluation by a non-cataract surgeon, but I digress. I would not want to suggest they are flying loose and easy with the facts, but rather that because they teach and pontificate they believe their stuff doesn't stink.

This concerns me. On the one hand we call them asking for help with a problem. On the other hand, they testify that we do not know as much as they do, conveniently leaving out that we're asking for help in their field of expertise, not ours.

Unfortunately, I now realize that some of our smiling academic colleagues follow the 25-cent-rule. Trace a quarter on the map around your city. Inside the line they're academic angels, outside it weasels (and here I apologize to the four-legged variety.)

Love and Objections

I love my academic friends and I count on their help, and I promise they can count on me if they ever need me. I try not tell others what's right for them but I do object when they do something wrong for me. I am concerned that there is a smarmy group of gownies who use their academic credentials to do battle against us townies. Unfortunately, a bunch of the boys in bowties are bastards, and they should back off because we're on to them. OM