Author Archives: hcolt

Risk normalization vs. an ethos of safety

Photo courtesy H. Colt

I recently returned from a trip to Zion National Park, in the beautiful state of Utah, where a tragic accident led to the death of a 58-year-old man who fell while rappelling in Pine Creek Canyon. Known for its massive sandstone cliffs, giant slot canyons, and challenging hiking trails, the park is a famous destination for rock climbers and canyoneers alike.  Just weeks earlier, in my home state of California, a 23-year-old experienced rock climber named Balin Miller made international news when he accidentally rappelled off the end of his rope after completing an ascent of the famous granite wall called El Capitan, in Yosemite National Park.

The problem with climbing accidents, whether from inattention, weather, climber and equipment error, or plain bad luck, is that they are unforgiving and often fatal. That is why so much attention is paid to accident prevention and to raising awareness about the risks of taking shortcuts or engaging, intentionally or unintentionally, in risky behavior. Miller, for example, was descending only a short distance to dislodge his equipment bag that had become stuck in a crack. He forgot or neglected to tie a knot in the end of his rope, ran out of line, and slid off the end to his death.

Accidents like this prompt me to think about the concept of risk normalization, also referred to as “normalization of deviance,” which describes how risky behaviors or operating in potentially dangerous conditions can become increasingly acceptable over time because of the absence of negative consequences. In other words, “repeated exposures to hazards without consequence lowers the perception of danger.” Think about texting while driving, bypassing infection control protocols, riding your motorbike without a helmet, or taking a casual approach to a risky activity. 

For individuals, organizations, and society-at-large, any drift in behavior, cultural acceptance of potentially risky behaviors without appropriate safeguards, and reduced perception of hazards are all linked to risk normalization. I am amazed, for example, at the lingering resistance to using checklists to assure patient and procedure-related safety in interventional pulmonology. Also, I am intrigued by hundreds of videos of successful complex bronchoscopic interventions presented at national conferences or on WhatsApp, but very rarely is there a discussion of “close calls” or of something that went wrong. 

Risk normalization is one of several invisible epidemics that threaten our overall well-being. It is fostered by complacency, desensitization, and an unwillingness, at times, to speak truth to power. It is a menace to professionalism that affects our ability, or reflects an unwillingness, to reason, and it represents a cultural drift away from vigilance and the ethos of safety and prevention. Health care environments, specifically in procedure-related aspects of healthcare delivery such as interventional pulmonology, are fertile settings for its development. 

Diane Keaton and altruism in the movies


Diane Keaton passed away on October 11, 2025. She was seventy-nine years old. Versatile and classy, she defined the roles she was given rather than letting those roles define her. During a fifty-five-year movie career that included one Academy Award (in Woody Allen’s Annie Hall, 1977) and numerous star-billings alongside male movie greats such as Al Pacino, Jack Nicholson, and Warren Beatty, Ms. Keaton, through all her complex characterizations of femininity on screen, both dramatic and comedic, made a significant mark on American cinema.

In one of her lesser-known films, Marvin’s Room (directed by Jerry Zaks from a screenplay by Scott McPherson), she portrays Bessie, a staunch and self-sacrificing woman who has spent the last twenty years caring for her mute, bedridden, multiple-stroke victim father, Marvin (Hume Cronyn), and her ailing aunt, Ruth (Gwen Verdon). Bessie’s life changes drastically when she learns she has leukemia and requires a bone marrow transplant. The rest of the film is a poignant exploration of family dynamics, responsibility, and the value of selfless caregiving in the context of renewed relationships Bessie establishes with her estranged sister, Lee (Meryl Streep) and Lee’s two dysfunctional children, the emotionally volatile teenager, Hank (Leonardo DiCaprio) and his ten-year-old brother, Charlie (Hal Scardino), all of whom may be eligible donors for a procedure that could save Bessie’s life. 

The film draws attention to the high emotional toll of individual altruism rooted in a sense of duty, family responsibility, and unselfish love displayed by family caregivers. Today, and for the foreseeable future, many medical conditions that were once fatal are survivable. An increasing number of people, therefore, find themselves taking on the usually unpaid, self-sacrificial roles of caring for sick or disabled relatives. Results from a recent study in the United States, for example, showed that more than 59 million Americans provide care for an adult with a complex medical condition or disability, and another 4 million adult family members care for a sick or disabled child. In the United States, despite help from job-protective legislation such as The Family and Medical Leave Act (which provides twelve weeks of unpaid leave, continued health benefits, and guaranteed job reinstatement for those working in companies with more than fifty employees), these responsibilities render caregivers extremely vulnerable to unemployment, job and opportunity loss, financial hardships, emotional burnout, and physical illness.

In Marvin’s Room, as in real life, altruism cycles back as Bessie, the self-designated family caregiver, becomes the person in need. In addition to dealing with her own severe illness and the consequences of her new vulnerabilities, she must struggle with the problem of who will replace her if or when she is no longer able to provide caregiving services to her loved ones. Sadly, this reversal of fortune is not uncommon. Yet, the realities of caregiving environments are rarely the focus of medical or surgical consultations, which understandably target disease diagnosis and treatment.

Not all patients have a champion who can knowledgeably advocate for their well-being. Films like Marvin’s Room are a gentle reminder that it is a moral obligation and professional duty for physicians and other health care providers to take it upon themselves to inquire about caregiving responsibilities for all patients, and, if possible, to offer support, assistance, and tangible solutions that might help family caregivers lessen their burdens. In so doing, health care providers not only demonstrate compassion, selflessness, and commitment, they also create opportunities for acts of medical altruism that express our humanity.

Dimensions of Medical Altruism


Medical altruism is usually considered a virtue that is critical to defining a physician’s moral character. However, one of its more noticeable manifestations is behavioral, reflecting compassion, responsibility, and a sense of moral obligation. Indeed, medical altruism translates into a commitment by health care providers to use their power, position, privilege, and knowledge in the best interests of others, even at great personal cost and varying degrees of effacement of self-interest. Therefore, medical altruism represents physicians’ spoken and often unspoken commitment to act selflessly for their patients’ well-being, regardless of potentially conflicting professional duties, even at the expense of personal gain, safety, or well-being.

American philosophers Pellegrino and Thomasma thus argued that beneficent altruism was morally obligatory for physicians, placing it at the root of a “virtuous” physician’s character. “No one can make the conscientious professional do what she thinks is not in the interests of the patient or client,” they write, and “The physician of character will…reliably be expected to exhibit the virtues of fidelity to trust and effacement of self-interest.”

Other manifestations of medical altruism might have their roots in a person’s psychological profile. In part, this is because medical altruism is almost always viewed as being individual-centered, and therefore, potentially at the core of a physician’s personal identity. For example, some physicians’ altruistic behaviors are linked to their heartfelt desire to relieve suffering. This is reflected by physician and bioethicist Eric Cassell’s (1928-2021) belief that “The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick.”  Dr. Cassell viewed suffering as a primarily subjective experience, describing it as “the state of severe distress associated with events that threaten the intactness of the person.”

A slightly different perspective was presented by Daniel Sulmasy, who is well known for his writings about the connection between spirituality and medicine.  He argued to reaffirm Sir William Osler’s declaration that medicine was a calling, not a business. Dr. Sulmasy is a physician and philosopher who once lived as a Franciscan friar. Focusing on a physician’s character, he suggests that altruism is a virtue easily threatened by a malfunctioning or flawed medico-industrial complex. He warns that unsound training environments and the stress/realities of day-to-day medical business practices can potentially erode altruistic ideals.

Richard and Sylvia Cruess argue that if medicine is a profession, then medical altruism is a professional duty. They believe altruism is at the core of the physician-patient contract and a centerpiece of the social contract between physicians and society: “Based on the literature, society’s expectations of medicine are the services of the healer, assured competence, altruistic service, morality and integrity, accountability, transparency, objective advice, and promotion of the public good.” According to this position, physicians have a professional obligation to engage in altruistic behaviors, the degrees of which can be hotly debated. Additionally, medical institutions and health care policies should promote and support altruism from a systems perspective because altruism is both expected and contractually anticipated by society-at-large.

This brief discussion of the various dimensions of medical altruism would be incomplete without acknowledging the work of recently defunct physician and anthropologist Paul Farmer (1959-2022). Dr. Farmer supported Article 25 of the Universal Declaration of Human Rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care….” He expanded upon patient-focused boundaries of medical altruism by proposing that health care providers be individual caregivers but also advocates in the battle to overcome social inequalities.

  • Pellegrino, ED and Thomasma DC. The virtues of medical practice. Oxford University Press, 1993.
  • Cassell, E. J. 1982. “The Nature of Suffering and the Goals of Medicine.” N Engl J Med 306 (11): 639–45.
  • Sulmasy, Daniel P. (1993). What’s so special about medicine? Theoretical Medicine and Bioethics 14 (1):379-380.
  • Cruess SR. Professionalism and medicine’s social contract with society. Clin Orthop Relat Res. 2006 Aug; 449:170-6.
  • Farmer, P. Pathologies of power: Health, human rights, and the new war on the poor. University of California Press, 2003.

Medical Altruism: It’s not simple


The concept of medical altruism, which is central to health care delivery and both patient and physician well-being, is extraordinarily complex. Filled with nuance and interconnected layers, even its definition is problematic. Usually understood as a dynamic, context-dependent virtue, medical altruism can be viewed as a commitment by medical providers (physicians, nurses, and other providers) to use their power, position, privilege, and knowledge in the best interests of others (their patients) even at personal cost and varying degrees of effacement of self-interest. Seen in this light, medical altruism includes in its essence altruism (“other-regarding,” as coined by nineteenth-century French philosopher August Comte), and the morally obligatory trait of altruistic beneficence (as described by American ethicists Edmund Pellegrino and David Thomasma), which goes beyond the principles of benevolence (wishing others well) and nonmaleficence (not doing others harm).  

Regardless of whether medical altruism is approached from a philosophical, psychological, theological, evolutionary, professional, or cultural perspective, it must be distinguished from the concept of altruism in medicine. While medical altruism is individual and profession-centered, altruism in medicine is viewed as a commitment of the health care collective, including its professional organizations, institutions, economics, sociocultural environment, populations, and political systems to address healthcare based on altruistic rather than egoistic or self-centered values. Altruism in medicine, therefore, might also apply to selfless patient-originated decisions to donate blood, stem cells, organs, and other tissues, as well as healthcare provider-originated decisions to volunteer for humanitarian activities, combat global inequities, or share knowledge, time, and experience in degrees that are above and beyond what is expected of their professional duties and, in the case of physicians, their social contract with society. 

Further complicating discussions of medical altruism and altruism in medicine is the rapidly changing face of medical practice and health care environments. There are obvious tensions regarding the value and sustainability of selfless motivation, just as there are significant vulnerabilities and systemic weaknesses of existing health care institution-based frameworks and societal policies regarding professionalism and what constitutes ethical medical practice in a technology-driven, soon to be AI-dominated twenty-first century. These and other elements relating to altruism will be the focus of several future reflections on Colt’s Corner. Please subscribe and share.

  • Pellegrino, ED and Thomasma DC. The virtues of medical practice. Oxford University Press, 1993.
  • Creuss SR and Creuss RL. Professionalism and Medicine’s social contract with society. Virtual Mentor 2004;6(4):185-188.

Are you a Hedgehog or a Fox?


The philosopher Isaiah Berlin structured one of his most famous essays about the literary masterpiece, War and Peace, by Russian author Leo Tolstoy, on a quote from the Greek poet Archilochus (640-685 BCE): “The fox knows many things, but the hedgehog knows one big thing.” Berlin essentially described a dichotomy of thought, practice, and philosophy, contrasting “hedgehogs,” who might view the world through a single unifying idea, and “foxes,” who thrive on adaptability and their breadth of knowledge and experience. 

Berlin argued that Tolstoy, like Shakespeare, Pushkin, and Michel de Montaigne, was a fox who drew on history and experience in formulating his vision of life, but ultimately wished he could be a hedgehog, who, like Plato, Dante, or Dostoyevsky, could view the world through the lens of a single overriding idea. Berlin succeeded in presenting these two very different and opposable approaches to life without favoring one over the other. 

Since its publication in 1951, however, philosophers, psychologists, business professionals, educators, political leaders, and scientists have ferociously debated the metaphor of the hedgehog and the fox. For example, just a few years ago, author David Epstein reflected on differences between hedgehogs and foxes in his best-selling book, Range: why generalists triumph in a specialist’s world, writing that hedgehogs (specialists) “tend to see simple, deterministic rules of cause and effect framed by their area of expertise…whereas “foxes (generalists) understand that most cause-and-effect relationships are probabilistic, not deterministic,” arguing the benefits of breadth and diverse experience in a world that incentivizes hyperspecialization. 

Medical education, and much of medical practice, is at a crossroads regarding the contrast between specialists and generalists. The fox-like health care provider values breadth, adaptability, and creative problem-solving. Applied to medical education, the fox embodies the need for diverse strands of knowledge, interdisciplinary collaboration, systems thinking, synthesis, and integrating humanities training into medical curricula. The hedgehog approach, however, has dominated traditional medical training to cultivate depth of knowledge, expertise, technical skill, and precise systematic thinking within a well-defined framework to understand and competently manage disease processes.

In my opinion, our challenge is to cultivate “hedgehogs who can think like foxes.” Ambiguity and doubt must not be viewed as weaknesses but as manifestations of our humanity. While alternate ways of thinking about pathophysiology, diagnosis, therapeutics, technology, and scientific discovery must always be considered, a firm and concise direction for each must ultimately be chosen, especially in fields where results are quantifiable and judged on evidence-based results.  

Our goal, therefore, is to be deeply grounded in scientific knowledge and understanding as well as to be both rigorous and flexible in thought and medical practice. Knowing the general distinction between hedgehogs and foxes, and recognizing which of these two approaches we align with most naturally during our lifelong journey through a rapidly evolving medical landscape, is an essential step to greater self-awareness.

  • Isaiah Berlin. The Hedgehog and the Fox: An essay on Tolstoy’s View of History. OceanofPDF.com., Princeton University Press. First published, 1951.
  • David Epstein. Range: Why generalists triumph in a specialized world. Riverhead books. New York, 2019.

Personality, Patients, and Personal Care


The Five Factor model of personality traits, also known as The Big Five, was conceived by psychologists to help explain features of human thinking, feeling, and behavior that are shared across all human populations regardless of race, gender, age, or language, differing only in the degree of their individual manifestations.  Research shows this hierarchal model, which organizes personality traits according to five dimensions: conscientiousness, extraversion, agreeableness, neuroticism, and openness to experience, is applicable across observers and cultures.

Understanding how these traits affect medical practice is important, not only to the physician patient relationship, but also to nurturing self-care, and to recognizing how certain strengths and vulnerabilities might impact teamwork, clinical care, overall performance, and professional well-being. Acquiring an awareness of these traits might also prompt initiatives that are crucial to personal growth during the lifetime of every practitioner. 

It is impossible to describe the details of these five dimensions in the space of a few paragraphs, but briefly, openness entails a doctor’s degree of willingness to embrace new ideas, technologies, structures, and perspectives. Conscientiousness might reflect a practitioner’s respect of ethical responsibility, manifesting itself, for example, as dependability and integrity. Extraversion, agreeableness, and neuroticism highlight interpersonal and emotional aspects of medical practice. They contribute to what is also referred to as Emotional Intelligence (EI), which is the ability to recognize, understand, and regulate one’s own emotions as well as the awareness of how those emotions might affect or influence others.

Health care providers face multiple challenges in the workplace, not the least of which are found in their interactions with patients. One often unspoken consequence of these interactions is the deleterious effect of a patient’s death or suffering on caregivers themselves. Being aware of how this manifests itself within the dimensions of The Big Five can be helpful in building personal resilience as well as a capacity for greater empathy and compassion, not only for patients and their families, but also for other caregivers, and importantly, toward oneself.

  • McCrae RR, John OP. An introduction to the five-factor model and its applications. J Pers. 1992 Jun;60(2):175-215. doi: 10.1111/j.1467-6494.1992.tb00970.x. PMID: 1635039.
  • Novikova, I.A. (2013). Big Five (The Five-Factor Model and The Five-Factor Theory). In The Encyclopedia of Cross-Cultural Psychology, K.D. Keith (Ed.). https://doi.org/10.1002/9781118339893.wbeccp054

Vulnerability and Resilience


At a recent pulmonary conference hosted by Sharp Healthcare in San Diego, I had the opportunity to discuss vulnerability and resilience issues in healthcare. One of my goals was to raise awareness about the tragedy of suicide among physicians and other healthcare professionals. Recent studies have shown that suicides are on the rise, and that among female physicians, for example, rates exceed those from among the general population. Registered nurses and health care support workers also have higher suicide rates compared to non-healthcare workers (16 versus 12.6 per 100,000 persons) in the United States. 

Health care providers, especially in high-stress environments and situations, face the risk of emotional exhaustion, moral distress, and burnout. One recent study, for example, showed that at least sixty percent of healthcare professionals feel burned out, costing the US healthcare system more than four billion dollars annually. As we learned during the COVID pandemic, health care systems are also vulnerable to factors such as economic stress, supply-chain disruption, and dwindling resources that can adversely impact their employees’ well-being.

My point, of course, is not the financial burden of this tragedy, but the cause. Vulnerability in healthcare workers’ health is linked for the most part to structural and cultural factors in the medical profession. Long hours, administrative burdens, emotional distress, and the stigma that prevents healthcare workers from seeking professional psychological support are just a few of the factors that contribute to increased risks of burnout, depression, and professional dissatisfaction. Not surprisingly, these might easily overwhelm one’s personal resilience (defined as the ability to cope with and recover from suffering, often in the face of adversity). 

The interconnectedness of resilience and vulnerability underscores the importance of institutional and professional societal structures to strengthen individual coping resources and address systemic contributors that hamper a health care worker’s well-being. It is time that we address these issues explicitly, in journals and national meetings, as well as locally in our medical schools and health care institutions. I am hopeful that, in a collaborative spirit of concern, care, and compassion that extends beyond the patient care arena, the current “younger” generation of health care professionals will give greater value to resilience-building and vulnerability acknowledgment than their predecessors. 

  • Jain L et al. Suicide in Healthcare Workers: An Umbrella Review of Prevalence, Causes, and Preventive Strategies. J Prim Care Community Health. 2024 Jan-Dec;15.
  • West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences, and solutions. J Intern Med. 2018 Jun;283(6):516-529. Epub 2018 Mar 24. PMID: 29505159.

Introducing the new BronchAtlas


Better lung health is within reach with our tailored solutions. Visit bronchatlas.com to find out how to
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Our mission at Bronchoscopy International has always been and still is to provide practitioners and trainees around the world with free, easily accessible tools that will enhance their ability to care for their patients competently. Our slide decks have been used by teachers and learners for more than twenty years, and materials from The Essential Bronchoscopist series of training manuals are used in educational programs around the world, as well as by individual practitioners as study guides. Our Checklists and assessment tools have helped change the paradigm of procedure-related training, successfully complementing the traditional apprentice-style mode of professional development and facilitating competency-oriented training for new procedures. I am proud to say that our study guides were the first ever provided freely to bronchoscopists and interventional pulmonologists around the world, and our teaching videos, many created long before the video teaching boom, have had almost two million views.

With the new and improved BronchAtlas, our goal is to bring bronchoscopy-related learning to the bedside using an easily accessible and practical telephone-based learning instrument. This modality is a vital tool that requires minimal technology and works around varying levels of infrastructure. It is one more step in the direction of democratization of knowledge, an essential step toward greater professional development and improving patient outcomes.

With BronchAtlas (connect to www.bronchatlas.com), health care providers, students, as well as patients can easily access information pertaining to bronchoscopy in special situations. Each “topic” is covered by a series of bullet points organized into FOUR easily read components: addressing the problem at hand, providing the solution, listing a set of references, and providing links to an instructive YouTube-based video from our Bronchoscopy Academy YouTube channel. It takes less than three minutes to view each topic, making this tool ideal as a refresher or handy problem-solver. 

We hope you will enjoy using BronchAtlas, and we encourage you to pass the link to the BronchAtlas website along to your friends and colleagues. More “modules” are coming, so please let us know which other topics you would like to see addressed. Also, if you would like to assist with authorship or as a video contributor, please contact us. We look forward to hearing from you!

On friendship and sudden loss


Like many physicians, my life was surrounded by death, and my professional ambitions were dedicated to postponing its arrival at my patients’ bedside. Yet, when death appeared, I spent hours in its presence, sometimes in silence, sometimes to comfort, and other times rebelliously fighting against its ultimate outcome. 

Grief was a constant companion, but not only as a manifestation of humanity. A patient’s death, I thought, was a loss that raised many questions. Could I have done something more, were the right technologies employed, was my care appropriately guided by my desire to offer surgical expertise in the glove of loving kindness. My own grief was almost always accompanied by a degree of self-doubt, professional considerations, and spiritual contemplation that sometimes dominated my emotional state.

When we lose a friend, lover, parent, child, sibling, or any sentient being with whom we are close, especially one whose life we’ve shared for many years in one way or another, there is no alternative to grief. All the more, when a death is sudden, shocking, or unexpected. In the beginning, the numbness caused by such sorrow feels irremediable. Whether by physical separation or rifts in our spiritual being, the separation caused by death is experienced like a dis-appearance, or as the Canadian poet, Anne Carson, might say, a profound absence that disrupts time and memory. 

The death of a loved one, therefore, is like a tearing of one’s soul…the French word for it is déchirure. Pronounced deh-shee-RRHEWR, the word’s lingering third syllable is difficult to pronounce. The ‘ru’ is a rough, guttural ‘R’ sound, whereas the final ‘re’ evaporates into space only after a final flow of air is gently expulsed from between the speaker’s lips. The word stops itself. Like death, it is definitive and persistent. 

It seems grief is the price of survival. But though it wounds, it also teaches us to love more fully, and to recognize that manifestations of our affections are fleeting gifts, not permanent possessions. We thus learn to cherish each day, and to acknowledge how the departed’s absence is really a transformation, an unbreakable integration of the other into our thoughts, memories, and hearts.

Shortly after learning of Yann’s death, I took a walk through the cemetery of Montmartre, near where I was living, in Paris. The next day, I strolled among the graves in Montparnasse and meditated in the shadow of the mausoleum of a musician we both held dear. I ventured then to the cemetery of Père Lachaise, not looking for the place where my friend’s ashes rest, but for the memory of a moment shared more than fifty years ago. 

A memory without words.

Value of courageous and unselfish leadership


Organizations everywhere risk struggling with internal conflicts or resistance to change, lack of transparency, unclear identity and vision, self-serving or ego-driven decision-making, and flawed groupthink. These issues can steer societies away from their goals to provide benefits to their collectives and the communities they serve. Hence, they jeopardize the organization’s future and may irreversibly harm the organization’s reputation. 

What applies to other organizations and society at large also applies to bronchology and interventional pulmonology (IP) associations around the world. The IP culture built around technical innovation, science, ethical practice, and unselfish assistance to patients everywhere has evolved favorably over time, but this has not been without facing many challenges. 

To cite one example of overcoming internal resistance to change (there are many others), the culture dates from an era when forward-thinking, independent but often self-reliant practitioners were dismissively labeled as “cowboys” by colleagues who were less inclined toward new interventional approaches. For many years, a few leaders had to dedicate significant time and effort to demonstrate the safety and value of their procedures, and to survive academically within more conservative academic medical establishments. Using “show and tell” lectures and retrospective studies – prospective and randomized studies would come later – they proved that certain interventions significantly improved clinical outcomes, quality of life, and patient survival. Gradually, they overcame resistance from colleagues, skeptical referring physicians, other specialists wary of competition, hospital administrators, and members of pulmonary societies who were, at their worst, obstructionists. 

Similar resistance was faced by those who challenged existing training methodologies. Significant energy was needed to move beyond the outdated apprenticeship model of medical education to more modern and complementary learner-centric and patient-friendly approaches. These include using inanimate models, simulation-based training, ongoing competency and skill assessments, checklists, faculty development programs, multidimensional curricula structured according to individualized needs assessments, a democratization of learning resources, and computer/instructor-assisted feedback methods. Today, it is universally accepted that patients must not suffer the burden of procedure-related training. 

Whether in establishing the value of a technology-driven medico-surgical subspecialty or in championing a novel means for training its practitioners, history demonstrates that persistence and resilience in the face of opposition will ultimately yield rewards. Courageous and unselfish leadership may often go unnoticed, but the benefits gained by practitioners, students, and patients alike are substantial and often life-changing. Leaders who feel disenchanted by their colleagues’ apparent lack of enthusiasm should be inspired by these words from former U.S. President Ronald Reagan: “There is no limit to the amount of good you can do if you don’t care who gets the credit.”