It's Only Common Sense

Three weeks ago a Medical School committee charged with devising guidelines for doctors writing letters of reference called for a policy that most observers say is indicated by common sense. According to the proposed code, anyone writing a letter of recommendation should include all of the information which he would like to know were he to receive the letter.

The "golden rule" of letter writing recommended by the committee is merely a reiteration of a custom that is, in theory, already status quo. However, as the case of the Harvard doctors who composed letters for a colleague convicted of rape illustrates, the "golden rule" doctrine may not be followed in practice.

President Bok requested the formation of the committee after it was disclosed that three Harvard doctors wrote highly flattering recommendations for Dr. Arif Hussain, a former Brigham and Women's Hospital (BWH) anaes-thesiologist, after he was found guilty of rape. The letters did not mention Hussain's conviction.

Although the Hussain affair was an extreme case, the committee argues that letters of recommendation today are generally much more positive than those written in past years.

As a result of open access to recommendations and a general decrease in academic standards, "letters of reference have tended to be less precise and to contain less information which might be interpreted as negative," the committee contends, "...the time has come, however, for greater candor and forthrightness..."

Unfortunately, there are few ways to enforce the committee's common-sense guidelines. Without the creation of an omniscient central review body, even if the Medical School faculty adopts the recommendations with few changes--a possibility that Med School administrators say is exceedingly likely--policing the "golden rule" would prove nearly impossible.

Some administrators and faculty members feel that the mere existence of the policy will nevertheless have an appreciable effect. "Pulling it together on paper this way will serve to remind people of what they already know," said Dr Elizabeth Hay, Pfeiffer Professor of Embryology and a member of the guidelines committee.

The circumstances around the Hussain affair that led to creation of the committee might also help to change reference writing practice. One of the doctors who recommended Hussain is the head of the BWH Anesthesiology Department, Dr Benjamin G. Covino.

"The whole medical community was really shaken by that," said Dr. Curtis Prout, associate clinical professor of medicine. "We all put ourselves in somebody else's shoes and think about how we'd feel if we accepted somebody and didn't know the full story."

Prout, who compiles the standard dean's recommendation for each Med School student based on letters from professors, added that he has already noticed a slight change in the tone of the reports from some faculty members.

Although most administrators and faculty members agree that doctors should strive to write more balanced--and truthful--letters, there are lingering fears about the implications such a policy might have for Harvard Med School students if carried out in practice.

"It would be as if grades were suddenly changed," Dr. Paul Snowden Russell, chairman of the guidelines committee, said last week. "We'd be doing something a little different from other universities--we don't want to damage people by seeming more critical."

Although the problem of consistency--both with other universities and with Harvard's past policy--could create difficulties in the first few years of a transition, most problems could be avoided by including a cover letter explaining the University's new policy. Marylou Handy, director of admissions at Cornell's School of Medicine, said that most colleges currently follow this practice when changing evaluation standards.

In the long run, administrators say, a more balanced policy of reference writing could benefit students by lending greater credence to the entire letter, and thus to its positive points.

Estimating that she has read 30,000 recommendation letters, Law School Dean of Admissions Molly Geraghty said last week. "The most effective ones are good news bad news mixed."

Dr. Harry Oberhelman, who as director of Stanford's General Surgery Program selects the program's interns and residents, agrees "The letters we receive are by-and-large always very favorable--it's a matter of how superlative. [If letters were more balanced] we might put a lot more faith in the letters we read."