“Well, you know, Gus, principles are expensive.”
I had just complained to my attorney that justice was not being served, and there were hard held principles being violated by the actions of another person.
He was willing to pursue the matter, but warning me that it could get expensive, and the outcome would not be monetary. I might get what was “right,” but it would be an expensive battle, and the outcome would not be guaranteed.
We describe a physician who has compromised his principles in working for a hospital or insurance company as a turncoat. He has left behind the Hippocratic Oath, and is working now for the presumably evil administration, has “drunk the Kool-Aid,” and apparently wants nothing but financial gain to the detriment of high-quality patient care. Their actions no longer speak to patient care, but to financial or personal gain, even to the detriment of the patient.
How did that turncoat get there?
Where do we draw the line between doing what is right and good for the patient and the goals and desires of our employers, medical directors, insurers, hospitals?
As I speak to physicians and administrators, the key phrase that distinguishes the principled and respected physicians and administrators from those who are not is transparency. Telling subordinates to do something a certain way is a habit and way of managing for some people.
There may be good and solid reasons for it, but the difference for physicians is we do not do well just being told. We want – no, we need – to understand.
We demand evidence-based practice when available, which means understanding everything we do is based on evidence, good practice or expert opinion. We need and deserve the same when being asked to do administrative or clerical tasks.
We bristle at being told to implement, change, and do things that don’t seem to make sense. We do not like to compromise our principles. Things must make sense, they must be supported by evidence, and when they do not, we protest.
Do you have a good thing you want us to do? Explain it to us. Give us the evidence, be transparent.
If you do not, we will draw our own conclusions, and they may be based on our perception, not necessarily on your true intent. Don’t ask us to compromise our principles. I may work for you, but that does not guarantee collaboration or cooperation if I feel or perceive it may not be in the best interests of my patients and me.
And, at times, there may be conflict between the two, and between those goals and corporate goals, and we need to work that out, openly and honestly. I can take a personal hit, I may even allow some compromise, but I need to know why. I can compromise for good reasons. But I need to know the reasons. Want to engage me? Be open.
Do you agree? What else is needed to engage us?