Acts 20:35 of the Bible says, “It is more blessed to give than to receive.” If pressed, many physicians generally believe it — or we think we do. But how many physicians actually offer professional courtesy — taking care of colleagues and the families of other physicians without charge? It seems to be a dying practice.
I gave free psychiatric consultations and discounted psychotherapy rates to many colleagues over the years. And when I was a resident, I received psychotherapy at a discount. Professional courtesy used to be offered by most specialists — not only psychiatrists — in the normal course of practice. A study from nearly 30 years ago showed that psychiatrists at 80% were less likely to offer professional courtesy than physicians in any of the other specialties, ranging from 91% to 99%.
In time, as my family grew, I found that professional courtesy was less important in terms of money and more important in terms of my colleagues’ availability. “Fever and ear pain? Sure, bring your child in to see me now,” our pediatrician once told us at 1 a.m. in order to quell the anxiety of two very worried parents. Doctors always seemed to be able to accommodate other doctors and their family members on a dime.
That’s not necessarily the case today, however. I have played the “doctor card” many times to get an expedited appointment for myself or someone in my family — to no avail. In a recent example, a relative was in treatment for depression, yet not improving, so I reached out to a young psychiatrist who came highly recommended. Like me, the psychiatrist was on the academic faculty of a medical school. I emailed the psychiatrist requesting the favor of an appointment ASAP, and I gave her a brief synopsis of the situation. I did not hear from the psychiatrist for several days, so I wrote again and asked the psychiatrist to reach out directly to the individual whose contact information I had previously supplied.
One week later, the psychiatrist wrote to me on her cellphone: “Hello, Dr. Lazarus. I understand your urgency and concern. However, I do not have the availability to accommodate your relative at this time due to very limited clinic hours due to research and administrative duties.” The reply went on to say that I should call the “intake line” for help, and that her colleagues are “fantastic.” I was also given the phone number of a facility to contact 90 miles away. I was dismayed by the psychiatrist’s impersonal and untimely response. I felt compelled to inform the chairperson of the psychiatry department. When I did, he wrote that he appreciated my feedback and that I should feel free to connect with him directly in the future, but he exerted no apparent pressure on the psychiatrist. He asked me if, had he given her an order to see my relative, I would still want to have the appointment under coercive conditions.
Subsequently, I had a conversation with a psychiatric colleague — a former department chairperson — about the incident. He lamented the good old days, a time when professional courtesy was a byword and psychiatrists were “complete” because they provided both psychotherapy and pharmacotherapy. Nowadays, psychiatric treatment is usually split between a psychiatrist and a nonmedical therapist — not an ideal arrangement. My psychiatrist friend muttered “millennials” as an excuse to explain the psychiatrist’s inaction. It seems self-preservation has taken root in many physicians these days, and although I understand the need for work-life balance, academicians have a tripartite mission: clinical care, teaching, and research.
I also understand there are pros and cons of offering professional courtesy, and doctors must be mindful of certain laws and regulations that could imperil their practice should they treat patients preferentially or give the appearance of impropriety. From my perspective, I was simply asking for quick service — a request from one professional to another. Perhaps even this component of professional courtesy is becoming obsolete. I remember discussing professional courtesy with a co-resident many years ago. The resident’s take on professional courtesy surprised me. She said she never identified herself as a doctor to an examining physician lest the physician deviate from his or her practice standards. Quite a commendable position, I thought, but not always feasible when there is a pressing medical concern for a family member or relative.
The original purpose of professional courtesy was to discourage physicians from treating themselves and their immediate and extended family members. The custom dates back to Hippocrates. In addition, recent studies have shown there is a benefit to volunteering one’s time: It helps overcome anxiety and depression. But with the increasing regulation of medical practice, there has been a shift away from professional courtesy to business as usual delivered impartially. Still, it stings when you’re on the receiving end. My relative found appropriate help, albeit 90 miles from home.
Arthur Lazarus, MD, MBA was a 2019-2020 Doximity Community Fellow and is a 2021–2022 Doximity Luminary Fellow. He is a member of the Physician Leadership Journal editorial board and an adjunct professor of psychiatry in the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.