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July 1989

They Call It CompetitionPresidential Address

Author Affiliations

From the Department of Surgery, Scripps Clinic Medical Group, La Jolla, Calif.

Arch Surg. 1989;124(7):771-777. doi:10.1001/archsurg.1989.01410070021005

It is not often that one has the opportunity to discuss a subject, personally selected, before a more or less captive audience with the sophistication of the membership of the Western Surgical Association. It is a distinct honor. In selecting this subject, I took the advice of Dr Dale Liechty, a former president of the Association, to editorialize. In selecting this title, I recalled a historical novel read many years ago, They Call It Patriotism, in which intrigue involved in the initiation of World War I was emphasized.1 Although intrigue is not, I believe, dominant in the changing role of competition in medicine and surgery, there are ramifications that permit a commentary. Samuel Johnson is said to have opined to the effect that patriotism in public life is the last refuge of the scoundrel. Manipulation of competition may be considered the last refuge of the scoundrel in medicine and

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