A Great Speech from a Great Man

The Man

Creech was a nationally prominent surgeon, researcher, educator, administrator, and editor. Above all, however, he was a humble, warm, and compassionate human being, beloved by his family, patients, trainees, colleagues, and friends. He died in 1967 at age 51 years, his lofty career cut short by reticulum cell sarcoma.

This man made many important contributions to the science and literature of medicine. Early in his career, he was a member of Michael DeBakey's surgical staff at Baylor College of Medicine. Subsequently, he succeeded Alton Ochsner as chairman of surgery at Tulane University Medical School, and later became the dean there.

As I learned of Creech's remarkable abilities, one in particular—his talent for prescience—caught my eye. In the late 1960s, Creech predicted that the traditional private practice of medicine of that time would cease by 1990 and that physicians would eventually become employees of community medical centers or the federal government. He also believed that college graduates with just one year of apprenticeship would assume most of the functions that practicing physicians normally perform. Physicians, in turn, would become system specialists.³ Because of these concerns, Creech spent the last 6 months of his life striving for a future healthcare system that medical professionals would design.

Oscar Creech, Jr., is remembered not only for his high ideals and notable accomplishments, but also for his courage, benevolence, and modesty.²

The Speech

The inspiration for Creech's speech came from an episode in chapter 16 of Carlo Lorenzini's (pen name, Carlo Collodi) children's classic, Pinocchio.⁵ Creech called his talk “The Voice of the Cricket”:

Pinocchio has been hanged by assassins, cut down by a falcon, and taken to the home of Fairy. The most famous doctors in all the realm have been summoned in consultation. One after another they arrive and place themselves around the bed of Pinocchio—a crow, an owl, and a talking cricket. The Fairy gives them a brief history of the case and then asks them a simple question: Is the puppet dead or alive?

Crow advances first, feels the puppet's pulse, then his nose, then the toe of his foot. Having done this carefully, he steps back and solemnly renders the following opinion, “To my belief, the puppet is already quite dead; but if unfortunately he should not be dead, then it would be a sign that he is still alive.”

Next the owl comes forward, examines the patient, steps back and says, “I regret to be obliged to contradict the crow, my illustrious friend and colleague, but in my opinion the puppet is still alive; but if unfortunately he should not be alive, then it would be a sign he is dead indeed.”

All the while, Cricket stands quietly by. He is a little fellow and except for a tall black hat, is quite ordinary in appearance. However, if one looks closely, it is evident that he is unimpressed by the performance of his fellow consultants.

“And you—have you nothing to say?” asked the Fairy.

“In my opinion,” replied Cricket, “the wisest thing a prudent doctor can do, when he doesn't know what he is talking about, is to be silent.” And with that he turned and walked away.¹

With that brilliantly constructed passage as a springboard, Creech presented, in a clear, easy-to-understand, and convincing fashion, examples of how some physicians use not only arrogance but also subtle forms of dishonesty to hide their mistakes or deficiencies. He ended his cautionary tale by urging the students to strive for competence and to be ever mindful of the cricket's words.

Regrettably, dishonesty at every level of our profession still exists and is growing.⁶ And human nature being what it is, dishonesty will never go away. No measures to reduce it will work unless we serve as role models of integrity and honesty for each other.

Arrogance, too, will never disappear. Its prevalence in our ranks is deplorable but understandable. As a group, we physicians are intelligent, have years of schooling and training, render decisions that affect the welfare of our patients, and historically answer only to ourselves. Patients, in turn, often foster our flaws by conferring superhuman qualities on us. To protect that image, we prevaricate when interacting with them or with our colleagues, and avoid stating the truth to ourselves. No wonder we become vulnerable to haughtiness, egocentricity, and feelings of omnipotence.

Two other points: 1) Arrogance is frequently a front for ignorance and may diminish as knowledge builds. 2) We should fight any godlike tendency with a proven “anti-deiotic”—humility mixed with honesty.

Finally, in the spirit of Creech, I leave you with a paraphrase of the cricket's advice: When you don't know what you're talking about or have nothing of substance to say, keep your mouth shut!