Rhinoceros: A Lesson in Conformity

It was about 18 years ago that I attended a family function in Ithaca, New York, home to Cornell University.  A young man named Jacob joined the Rabbi on the podium, who proceeded to give him a sermon on the dangers of conformity.  The Rabbi deftly interwove this theme from Eugene Ionesco’s play, Rhinoceros.
From where I sat Jacob wasn’t at risk of conformity, but I didn’t know him well enough to make that judgment call.

What I did know was that the message of Ionesco’s play was among the more powerful ones I had ever heard.  I rushed to buy a copy and was captivated by the plot.  The first production was in Paris in January, 1960 and in April of that year, the London production by Orson Welles at the Royal Court Theatre featured Laurence Olivier in the starring role.  Not too shabby.

The upshot of the play was that one by one, the townspeople began to metamorphose into rhinoceroses.  There were subtle signs at first such as skin turning a shade of green and gradually thickening, a small bump on the forehead, and changes in appetites.  Olivier’s character is the voice of reason, calling attention to the changes, while he progressively shrinks into the minority who retain their human-like features and qualities.  Townspeople are in denial, disputing the evident as the absurd, as one by one they morph into rhinos, joining the nightly stampede.  At the end he is the last man standing, fiercely clinging to his humanity, ultimately refusing to capitulate.

I was reminded of Rhinoceros when a former patient nodded to me in Starbucks this morning:  “You’re Dr. Press, aren’t you?”  This led to a conversation about how she “couldn’t come back to my office” because I don’t take her insurance any more.  Years ago I had written a parody of Rhinoceros called “ManagedCare-Ceros”, in which health care providers morphed into providers for managed care plans.  Their skins thickened as they took lumps on their forehead, one by one joining the stampede toward the privilege of running with the herd, in denial about what they were sacrificing, rationalizing the commoditization of care.

“You know I went to X-Vision and really wasn’t happy, so I may have to bite the bullet and come back to you”, my former patient shared.  I told her that it was gratifying to hear her arrive at the conclusion that some services were worth paying for out of pocket, but that my practice had evolved more toward specialty care.  As we do with all vision care plan alumni in our office, we would refer her to capable optometric colleagues who provide primary care, enabling us to concentrate on our specialty of developmental vision.

And with that, I pulled Ionesco off the shelf before leaving the office this afternoon, celebrating another day of non-conformity.

About Leonard J. Press, O.D., FAAO, FCOVD

Developmental Optometry is my passion as well as occupation. Blogging allows me to share thoughts in a unique visual style.
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11 Responses to Rhinoceros: A Lesson in Conformity

  1. Chuck Allen says:

    And this week I experienced the pleasure of “dismissing” a patient. She had been a annoying patient for about 17 years during which we continued to provide her with the best vision correction in glasses and especially contact lenses; because she hated to wear glasses in public. Every visit had to be an emergency for which she would be put into an allready full schedule and then take up more than 1/2 hour with minutia of what is wrong with her vision; why can’t she see like she used to. The explanation of presbyopia for female hyperopes who remember being able to see wihout glasses nevere seemed to stick. She would always get her contact lenses and glasses at Costco but I would be evaluating diagnostic soft multifocal lenses, one after another, and another, and another! There was always the “emergency call” that she was going away and surprisingly the last lenses we had prescribed six months ago never reallly worked but she needed something to hold her over until she could make an appointment after she returned from yet another vacation. When she was presented with a bill for a minimum office visit ($75) she refused to pay for it as she felt that the fee $75 charged in December of 2009 should have covered the visit in June, 2010.

    Yesterday she received a certified letter suggesting that she find another practitioner to provide her with care similar to what I had provided her for so long, but thanking her for giving me the opportunity to solve all of her vision problems and ensure the health of her eyes. In 49 years of practice the day finally came. Mailing that letter really felt good.



  2. Dan L. Fortenbacher, O.D., FCOVD says:

    Funny you mention – Rhioceros by Ionesco, my son Charles “Chuck” Fortenbacher had the lead role of Berenger in the Grand Valley State University performance in April! A very funny tale adapted from the existential theatre movement in France known as “theatre of the absurd”.

    I never thought of it until your post, but now that you mentioned it would seem that our US health care system is starting to look like Ionesco’s play…everyone is turning into rhinoceroses!

    • Wow, Dan. An Olivier in the making! I love the back cover description of the Grove Press edition of Rhinoceros, which reads: “Rhinocerous is a commentary on the absurdity of the human condition made tolerable only by self-delusion. It shows us the struggle of the individual to maintain integrity and identity alone in a world where all others have succumbed to the ‘beauty’ of brute force, natural energy, and mindlessness.”

      Yes — a sad commentary on the US healthcare system, and bravo to those of us who combat the popular trend through Berengerism.

  3. Daniel Wohlgelernter says:

    wonderful essay, Len. Yes, the moral lessons of RHINOCEROS are applicable to the ongoing transformation of health care delivery and funding, as well as to the international political scene. I remember being struck by the message that the initial apathy of the public was the root cause of the Rhino metamorphosis. Whether it be fascism, socialism, jihadism, or HMO-ism , indifference and irresponsibility are the prerequisites for the flourishing of such toxic ideologies.

    • Thanks, Dan. You are correct about initial apathy being the culprit, and the shirking of social responsibility as fodder. But there’s also a strong message about the fortitude required to resist peer pressure. When you have the chance, give it another read. In these times it’s like re-visiting with an old friend who still shares your values.

  4. WC Maples says:

    I am struck by the fact that now, those with insurance appear to pay more on their copay than what we once charged for our total services. In the scheme of things, the optometric care is minimal compared to a visit to the hospital for a day or even the emergency room.
    We have indeed morphed.

    • Nice nail head hit, WC. There are several interrleated issues at play:

      1) The public has come to use “health care insurance coverage” as an entitlement to any services provided by someone with a Doctor’s title. Here’s my card and my co-pay, and we’re good to go for everything. Health care coverage was never intended to be that. Or perhaps better stated, should not have been crafted to create that perception.

      2) The proflieration of Managed Care and HMO plans, designed to make CEOs, CFOs, and others near the top of the financial chain very wealthy, simply re-directed reasonable profit from thousands of doctor’s pockets to a more select few corporate pockets. So-called health care cost-containment never occurred, which could have been predicted by lifting the rug and looking at the top of the pyramid scheme.

      3) Paralleling the profit re-distribution, expenses were re-directed from patients to their employers. The expense re-distribution aided in bankrupting businesses at the same time as the profit re-distribution drove doctors into other professions. It is not uncommon to find doctors who continue to practice, but bemoan these factors and rely on other businesses they’ve invested in to substitute for the profit re-allocated to corporate entities.

      4) None of this could have occurred without the public accepting the commoditization of health care. According to third party dictates, if one agrees to be a par provider, the Optometry graduate on her first day in practice has as much worth as you or I. If the public were to find this absurd, rather than selecting a provider because “she’s on my plan”, then the third parties who made a mockery of experience and expertise would never have thrived.

      5) That is the message of RHINOCEROS. Doctors who render specialized care really can’t afford to put the intense effort to excel at their services if they are commoditized. The system therefore breeds mediocrity. That is not how health care innovation in this country flourished. While those who have conscripted free access to create insurance fiefdoms would have you believe that those of us outside the system are guilty of “concierge healthcare”, the wheel is turning. Patients can perceive when their needs are being met, as compared to having third parties capriciously decide coverage based on arbitrary and inconsistent benchmakrs. As Dr. Dan notes below, public apathy is at the root of this mess, and public action will clean it up. I would add that doctor activism is required as well. When a critical enough mass of doctors take the bold step of working for the patient instead of working for insuance companies, a healthy balance will be restored to the healthcare marketplace.

  5. My office accepts just a few vision plans and no health plans other than Medicare. I have in the past mentioned to my staff that one of my long term goals was to be free of vision plans. The idea was completely foreign to them and they didn’t think it would be possible. This shows that the power and influence extends further than our patients, but to staff and even doctors. In fact, we optometrists were implicitly taught that vision plans were to be included in the thought process of patient care in the earliest days of optometry school.

    It does take being a non-conformist to enVISION a way out of this situation.

    • Excellent point, Nate. Staff tends to project their values onto the patient. If prior to being in your employ, they selected their eyecare provider primarily based on who was “in their plan”, their perception that your office is worth coming to beyond the limited view is crucial. Equally important is spreading the confidence among your colleagues that patients will come because they’re opting for something beyond “what the plan allows”.

      Excellent point as well about students tending to role model what they are taught in school. I understand the need for Schools to be par providers because of the nature of their teaching clinics and their geographical socioeconomics and in fact, that’s part of the solution for our health care dilemma — but more on that another day.

      Hopefully the Plan Mentality will become less of the student culture as they are increasingly exposed to external practice externships and residencies, where they can role model practice management trends breaking free of the Plan Mentality.

  6. Pingback: 2010 in review | Pressvision's Blog

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