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Lawyers are regularly compared with physicians as an educated profession. Both require long years of expensive graduate education to practice; both types of schools are strictly gated to those with the right combination of grades, test scores, money, connections and ethnicity. Law and medicine represent two of the three learned professions since even the Middle Ages (along with the clergy), and are considered great pathways to upper-middle-class respectability.

Of course, there the similarities end.

Law is saddled with a rather unsavory reputation. According to this Gallup poll, only 21% of respondents rate the honesty and ethics of lawyers favorably. Attorneys are considered amoral, rapacious, backstabbing mercenaries until proven otherwise. Jokes at the expense of attorneys have been around forever (“What do you call a hundred lawyers at the bottom of the ocean?”), and outside of courtroom shows, you can bet that any lawyer in fiction is going to be a villain. Heck, even in courtroom shows, any opposing attorney that’s working against the heroes will invariably be portrayed as the stereotypical amoral attorney, willing to sell his own mother in order to win a big case. In addition, many people simply see no value in the profession. The only reason you need an expensive attorney is because the other side has one; just think if we could get rid of all the attorneys!

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The end result for this negative presumption? Most lawyers know their image starts in the hole for any prospective client. Not only do clients never see lawyers as more moral or good than themselves, but they often see them as certified scumbags no better than Saul Goodman until proven otherwise. So, attorneys must work twice as hard and be three times as honest as anyone else, lest they join the growing scrapheap of unemployed JD’s. Any time I call a law firm, I get prompt and courteous responses within a day, even from the most high-falutin’ white-shoe firms around. One counselor even helped me out pro bono on a case when I could not afford him, until I found other representation, simply out of the goodness of his heart!

The horrible perception of their profession makes most (not all!) lawyers far more honest and ethical than most people can give them credit for.

Now let’s turn to the public image of medicine, and how that impacts physician behavior.

Doctors enjoy the benefits of a virtual halo upon greeting a patient. Most people unwisely assume that most physicians are there “to help people,” as opposed to milking them for money. In that Gallup poll from earlier, MDs get a 65% favorable rating, second only to nurses. The vast majority of TV doctors are heroes and lifesavers, selflessly sacrificing their time, their emotions, even their health to save their patients, often while something maudlin like “How to Save a Life” plays. Even jerkass docs like House or Dr. Cox were ultimately working for the benefit of their patients — certainly, neither were in it for the money. Rare villainous physicians like ER’s Rocket Romano serve mainly as foils, to show how saintly the other docs are by contrast.

The end result for this positive presumption? Most doctors know they enjoy a starting place of elevated moral image — any many then exploit this vulnerability in their patients to the fullest. Call it the Disney Effect: an overly benign or nice public image lets an entity get away with all kinds of shocking depredations, as an inverse of the Lawyer Effect from before. The vast majority of cardiologists at Las Vegas’ most important hospital were getting kickbacks from a medical device company, for example; surgeons sexually assault their anesthetized patients more than you would like to know. Dr. Oz exploited his benevolent image to hawk snake-oil remedies of questionable value and even more questionable ethics, simply to make more money. And don’t get me started on most medical bloggers, who love to portray themselves as somewhere between the Buddha and Jesus.

I can tell a few personal tales here. I rarely can get other physicians to answer the phone about a patient or send over charts, because they are generally too arrogant to care. When I call over to the ER when I’m sending over a patient, the most common result is for their attending physician to hang up on me. The second most common result is to “uh huh, uh huh” everything I’m trying to tell them about the very sick patient, before hanging up on me. (I get they’re busy. So am I.) I once worked for a physician who had intentionally gotten an investment bank executive, whose corporate HQ is in Battery Park, hooked on powerful IV narcotics, because the doc knew how rich his mark was. As a result, the poor guy had to visit nearly every single day for his fix, lest he go into withdrawals, at staggering out-of-pocket expense. This noble healer also owns a CT machine; he mandates patients to be sent for CT scans for any conceivable reason, at great cost of radiation exposure and cash. Oh, he only accepts cash and not insurance, did I mention that? Also, a local neurosurgery group’s rep once told me — and then asked me to forget she said — that they are moving to only working on patients with gold-plated insurance plans, and discontinuing seeing Medicaid patients. These fuckers all are already richer than Croesus. And they make a goddamn investment-bank executive look like a victim by comparison in their sheer greed.

what REAL neurosurgeons think about Medicaid patients

what neurosurgeons think about Medicaid patients

So, no. Do not assume I’m better than you in any way when you come to my clinic. All you can count on is that I will probably know more about health and medicine than you, and that’s it. It doesn’t make me special any more than knowledge of cars makes your mechanic special — or knowledge of law makes your lawyer special.

Do not assume I’m anything but a greedy, uncaring S.O.B. just out for myself, willing to screw over my patients to make a buck, until proven otherwise. The reason why I say this is because every patient should have this assumption about every physician they meet until proven otherwise because as I’ve seen in the news and med school and residency and practice that a lot of these people are some of the worst, most amoral shitbirds I have ever seen.

I will never allow myself to sink to this level, and I am blessed to work for a group that doesn’t screw over the patients for cash. But… you have no way of knowing this if we’ve never met. Always be vigilant, always be quick to ask for a second opinion, and always be ready to leave and never go back.

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