Rejected Images–and The Lessons They Teach

Sometimes you can learn as much from the wastebaskets in a magazine’s office as you can from the gleaming new issues in the lobby. Notes from a meeting on this month’s cover are all that’s left of one editor’s proposal to symbolize the leisure time physicians gain when they accept a salaried position. That editor (okay, it was I) was rightly outvoted for suggesting a picture of a golf bag. The image represents leisure, but also evokes an old cliché about physicians and the fairways that might offend some doctor readers.

A colleague didn’t fare much better with the idea of a time clock as an emblem of salaried employment. This time it was HMOs and other employers of physicians who could, we feared, be put off. The idea of employees punching in and out smacks of factories and assembly lines–the very last notion of themselves that managed care organizations wish to encourage.

Instead, as you’ve seen, we chose an image of the shingle some physicians have relegated to the attic as they’ve accepted salaried positions–the shingle most of their colleagues now emerging from residency won’t hang up to begin with. But I wonder if there isn’t something to be learned from the pictures we discarded and our reasons for discarding them.

The physician’s role in society has long been special. Poll findings suggest that the public still views doctors with a tinge of envy–witness the golf cliché and the popular notion that physicians are overpaid. But that envy is combined with a level of esteem that others–Congress, for example–can only dream of. One challenge for salaried physicians is to avoid being misperceived either as country clubbers or as clock-punchers, and in so doing to build on the respect they already enjoy to help patients develop a new accountability for and participation in the maintenance of their own health. Such patient accountability, happily, is one idea we didn’t throw out; you’ll find it discussed in John La Puma, M.D.’s Ethics column.

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