Correspondence and Brief Communications Correspondence and brief communications are wel- comed and need not concern only what has been published in this journal. We shall print items of interest to our readers, such as experimental, clinical, and philosophical observations; reports of work in progress; educational notes; and travel accounts relevant to plastic surgery. We reserve the right to edit communications to meet requirements of space and format. Any financial interest relevant to the content of the correspondence must be disclosed. Submission of a letter constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the journal. Any stated views, opin- ions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such letters. JUST STOP OR JUST COMPLAIN Sir: Dr. Sean Boutros makes a well-intentioned plea for a pos- itive outlook on plastic surgery in “Just Stop” (Plast. Reconstr. Surg. 111: 1355, 2003), but we offer slightly different advice to our colleagues. To those who are currently quiet, please just complain. To those who are already speaking out, please be more vociferous! What is the line that demarcates complaint and advocacy? Are we complaining when we argue for a patient to receive a breast reduction to relieve pain? Is it complaining when a breast cancer survivor needs our support to undergo a pro- cedure to restore her sense of femininity? Should we be silent when many of us waste billions of dollars on defensive med- icine lest we be sued for leaving some pebble unturned? Why should we not speak out when we are forced to dictate notes to fill a relatively capricious Evaluation and Management template checklist as opposed to providing real care? Is it being bitter when we write second and third letters of appeal to managed care companies as our patients’ ombudsman? These difficulties are part of medicine’s complex land- scape. We have chosen to love this profession despite all its difficulties, but with that choice, we have also undertaken a responsibility to change the status quo. It is our duty to com- plain or, at the very least, to support those who advocate on our behalf. As members of several plastic surgery and medical societies, we joined organizations of colleagues and compa- triots who, precisely because they do complain, protect the integrity of our field. Our dues pay to organize these “com- plaints” so that they may champion our rights and those of our patients as effectively as possible, protecting them from charlatans and upholding the highest standards of care for our profession. As academicians steeped in the difficulties and joys of practice and as wide-eyed medical students about to embark on a surgical career, we do not chastise those who complain, and in fact, we encourage others to join in with our chorus. After all, if we do not complain, who will? DOI: 10.1097/01.PRS.0000089262.60250.B5 Navin Singh, M.D. Plastic and Reconstructive Surgery Johns Hopkins School of Medicine, and R. Adams Cowley Shock Trauma Center University of Maryland School of Medicine Baltimore, Md. Anand Mehra Columbia College of Physicians and Surgeons New York, N.Y. Correspondence to Dr. Singh Plastic and Reconstructive Surgery Johns Hopkins School of Medicine 601 N. Caroline Street McElderry 8130-C Baltimore, Md. 21287-0981 nsingh@jhmi.edu REPLY Sir: There is no doubt that we have not only the right but also the duty to voice our concerns to bring about a positive change for both the patients and ourselves. However, our duty extends with the responsibility to choose a venue and tone appropriate for our profession. Our profession is more than an occupation. It is a sacred relationship to our fellow man. From the child with a cleft lip to the woman with an aging face, we are charged to do whatever we can to make their lives better. It is a gift and a privilege, and we should not forget it. As educators and leaders of the field, the efforts to bring about a positive change should be strong but carefully cho- sen. The labor should be targeted to those settings that will help accomplish our goals and should not serve to embitter residents and medical students. The point of my original letter is best illustrated by the fact that a medical student coauthored the response. Someone who has embarked on a career in medicine with lofty goals should be wet with anticipation for the times ahead. The fact that medical students around the country who have yet to feel the joy of helping or healing are complaining only attests that we as a group have not fulfilled our duty to the next gener- ation of doctors. As mentors for the neophytes, we should fuel the excitement and passion inherent to helping and healing and not the difficulties associated with our mission. Again, improving our ability to fulfill our charge is ex- 1947