THERE is something very irritating about the phrase "you are the only sane psychiatrist I know." While the speaker may think that it is a compliment, the person on the receiving end (if indeed he or she is sober or sane) can perceive a snide and subtle insult. It is one of those tensions that exists among different groups within a profession and it speaks to the complicated, subtle hierarchies in medicine in which we tear the other guy down to avoid knowing his field while building ourselves up. It is no news to any reader of this journal that medicine is under siege. Confronted with PPOs, HMOs, IPAs, Gatekeepers, DRGs, insurance reimbursement problems, and corporate medicine, it might be wise for us to recognize that divisiveness among physicians weakens us in the face of such important complexities, if not adversaries.
Exhortations rarely lead to changes in behavior, and what