Eyeworld

EW NEWS & OPINION October 2015 27 genuine, demonstrable, and, above all, personally meaningful?" EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since has occurred when unquestioning obedience was manipulated immor- ally. Advertisement exploits the art of connotation. Cialdini speaks to 3 symbols connoting authority: titles, clothes, and trappings. Alarmingly, these are all that are necessary to convey automatic influence. None need be true. Some advertisements are brazenly honest—"I'm not really a doctor but I play one on TV." Ads once featuring Robert Young who played Marcus Welby, MD, were far subtler. The local ad previously mentioned includes title, "doc- tor"; clothes, "the white coat"; and trappings, "the indebted patient in the OR setting." Ethical? That's for others to decide. Fair? I think not. Well-publicized examples of questionable influence wielding emerge across medical practice. Ophthalmology? I was recently asked by a patient, "What's up with cataract surgery?" Her friend recently spent more than $3,000 of her own money for cataract sur- geries that, years ago, my patient's health insurance paid for. Fearing something amiss she wondered what had changed. Earlier, a friend of my assistant reported that a relative was told by his eye surgeon that insurance would pay for the "older" surgical method but he might con- sider the new, "better"—reportedly the doctor's word—procedure for an additional out-of-pocket charge. According to the website of the Pension Rights Center, "in 2013 half of all older households received less than $35,611 in yearly income from all sources (my italics)." Out-of-pock- et expenses are daunting to most older folks. Cialdini advises that people can protect themselves from "profiteers" by asking: (1) Is this authority truly an expert? Are his credentials appli- cable to this situation?; and (2) how truthful can I expect this person to be? The latter question is extraor- dinarily relevant when the expert stands to profit materially from the exchange. Psychosocial research has uncovered heuristics of automatic behavior across all cultures. Two per- tinent stereotypes are: "price = qual- ity" and "expensive = good." If phy- sicians are to earn the respect and confidence of patients and society at large, we might ponder a correlated thought experiment: "If I didn't stand to earn additional dollars from this intervention, would the cost to my credulous but expectant patient be justified by benefits that are 1983. He has been a member of ASCRS for more than 30 years. Contact information Noreika: JCNMD@aol.com

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