GOLF MEDICINE AND MEDICAL GOLFERS.
We actively read the Christmas paper of Koplewitz et al. that was gifted to us by the 2018 BMJ Christmas issue and think that some observations can lead to three additional conclusions. 
First, our attention was attracted by the fact that the 8 best handicaps were observed in Surgeons while the eight lowest handicaps were found in medical physicians. Intuitively, one could suspect that the upper limb training of surgeons would facilitate precision of arm movement. Nevertheless, another unexpected explanation may arise from the figure associated to the article. Surgical pyjamas might be comfortable for surgeons playing golf. Nevertheless, we would strongly recommend the medical physicians to remove their stethoscope from their neck or pocket (as the physician drawn in the figure apparently did) but also (contrary to the image) to remove their white-coat while playing because it is likely limiting the quality of their swing!
Second, the authors conclude that association of golf practice among doctors with costs of care, remains to be studied. We agree with this, but advocate that authors should have cared for cost, rather than question “cost of care”. We analyzed the correlation between average doctor salaries,  and the percentage of golfers by specialty reported. Although data from some specialties were missing (31 available pairs), we found a strong relationship between the average annual salary of doctors and the proportion of golf players among a specialty (Proportion = 4,4066ln(salary) - 51,149; r=0.750). Of interest is to note that the zero intercept of this log regression is 109904 $. Whether or not this minimum is similar in other professional activities or other countries remains to be studied. As an intriguing observation, the present author occasional plays golf despite an annual salary below 100 000€ (his handicap, even without wearing his white-coat on the course, is far above 18).
Third and last, golf has been classified as one of the sports providing the lowest static and dynamic components by the American College of Cardiology. As a result, it is one of the sports activities that can be sustained even in severely affected cardiovascular patients. This is possibly the reason why cardiology is the medical specialty with the highest proportion of golf player. Similarly, some studies suggest that golf is one of the two sports with the greater number of exercise injuries. This is possibly the reason why the highest proportion of golf player was found in orthopedic surgeons. We suspect that regular contact with golfers could be a specific motivation for these two specialties.
In conclusion and as a consequence of our observation, we advocate that even for doctors, golf: 1/ requires adapted clothing; 2/ appears to be a socio-economic indicator; 3/ probably remains a largely used professional networking tool.
1 Koplewitz G, Blumenthal DM, Gross N, et al. Golf habits among physicians and surgeons: observational cohort study. BMJ 2018; 363:k4859
2 Anonymous, https://www.sokanu.com/careers/doctor/salary/
3 Mitchell JH, Haskell W, Snell P et al. Task Force 8: Classification of sports J Am Coll Cardiol. 2005 Apr 19;45(8):1364-7
4 Kim JS, Park HS, Oh SS. An analysis of the characteristics of sports activities and injury experiences of leisure sports participants. J Exerc Rehabil. 2018 Jun 30;14(3):407-412.
Competing interests: No competing interests