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July 16, 1982

Golden Rule

Author Affiliations

The Johns Hopkins Hospital Baltimore

JAMA. 1982;248(3):368. doi:10.1001/jama.1982.03330030066033

A physician who orders a test or procedure does not usually perform it or pay for it, nor, often, has he undergone it. While this insulation is generally helpful, it tends to emphasize advantages over disadvantages. To overcome this, the following variations on the Golden Rule, inculcated in me by a distinguished clinician-teacher, David Seegal, MD (JAMA 1961;177:641-642), have proved helpful.

Rule 1.—  Order a test or procedure only if you would be willing to do it yourself. Exception: If you have a financial, research, or educational incentive for performing it, skip to rule 2.As an emergency room intern, in what now seems the prehistoric era—before Medicaid—when a patient needed a hematologic test or urinalysis, I did it myself. Technologists now perform these tests, allowing physicians to continue examining patients. While this represents an advance, there was one benefit of the past practice: If I had to stop and