A Greater Responsibility

AFTER NEARLY three months of hearings and deliberations, a Medical School committee recently recommended guidelines for those who write letters of reference. The committee's report called for a few concrete changes--suggesting that letters be addressed to specific individuals and that authors describe their relationships with the doctors under consideration. But the core of the report--its "golden rule" policy--confirms the ancient maxim that sometimes nothing is as difficult to see as the obvious. The proposed code--which would require anyone writing a letter of recommendation to include all information that he would like to know were he to receive the letter--seems little more than "common sense."

We commend the Med School for reviewing its policy towards letters of reference and add out voice to those already calling for adoption of the committee's code. Its swift acceptance is particularly important given the heinous nature of the incident from which the recommendation report stemmed--the case of the two Med School doctors who endorsed Dr. Arif Hussain, a convicted gang-rapist, for a Buffalo hospital job.

However, we hasten to remind the Med School that any successful policy requires more than words. Its new "common sense" doctrine has already been widely and tragically flouted: the school has even had to form a special committee to remind doctors of their responsibilities. The Med School must thus put both its moral and institutional force behind its words. In the future, the school must immediately sever all its ties with doctors who write such misleading or morally dishonest letters of recommendation. The threat that a doctor caught in a serious error of omission, would have his ties instantly and automatically cut would almost certainly insure greater care.

We stop short of calling for scrutiny of individual recommendations because it would prove both impossible and undesirable. A central review board--the only feasible way of scanning all letters of recommendation--would not only invade privacy rights, but would probably insure that most letters would be substantially identical. But, while the "golden rule" policy may prove difficult to police on a regular basis, it can be strengthened through vocal advocacy and vigorous enforcement in cases of negligence that come to the school's attention.

Although the Medical School must ultimately enforce the policy it decrees, doctors in general should carefully scruntinize their own recommendatior. For some, this has meant they must portray that person in the most positive light possible or refuse to write the recommendation. In considering this issue, doctors must consider their obligations to the individuals they recommend but must not forget their far greater responsibilities to a society that could be seriously impaired by the services of an unethical doctor they recommend.