Are we our own worst enemy?

Are we our own worst enemy?

This post was originally published on 5/29/2013

Much has been written about medical teams. Some feel the new role of the physician is as part of a team, and not the leader.

While there is no “I” in team, they work best with someone in a lead role. But even with a leader, teams must be a cooperative, collaborative effort by people with different skills, laboring to bring care (in the medical concept) to the patient (who is also now a part of the team).

In some cases physicians have become suspect and distrusted team leaders because of the bad behavior of a few within our ranks.

Teamwork is a skill, one which not all of us have built in. Those of us who trained 15 or more years ago were told we were the captains. While there were others who worked with us, we were always the leader.

The challenge became how best to lead, direct, command and decide what was best for the patient in the new era of care, with not enough physicians. You can see the challenge.

Like any leader with power, power can corrupt. Good leaders lead with vision, direction, inspiration and a clear sense of right. Bad leaders can demean, belittle, demand, and serve themselves, even if they have the patient’s care in mind, and worse if they don’t.

There is a time and place to command people around you. In a code or an acute severe trauma, having a situation “commander” is necessary.

But in the new order, that commander must be a benevolent authoritarian and not a cruel dictator. The image of the physician throwing a chart or shouting and belittling those around them, commonplace many years ago, has mostly been suppressed by the new order and new guidelines about acceptable behavior.

Behavior not conducive to the best care delivery is not acceptable, and there are ways and methods to deal with the behavior. Physicians and administrators learn quickly the right methods and techniques to handle that.

But what about our non-clinical behavior that impacts clinical care and our image? Who is controlling that?

A physician in Michigan commits $1.6 million in Medicare fraud. A doctor in Milwaukee is charged with 13 counts of health care fraud. A physician in Alabama goes to jail in a $1 million fraud case. What schemes and what a bad name for the rest of us.

These physicians got caught. But what about tiny wrongs? What about keeping a patient who is stable and ready for discharge in the hospital for an extra day or two? They’re comfortable and they need just a bit more time to recover, right?

Or the patient who is sent for unnecessary surgery, by any clinical standard, because: “You know sometimes these patients get better if you just open them up!” Or the violation of national guidelines written by a professional organization that results in an unnecessary readmission because: “Well, those guidelines don’t apply to me.”

Is the team the solution to these tiny frauds? Will the team be empowered to tell the captain he is wrong? In a good team, one hopes so.

Let’s not create teams that are intimidated, but teams that are empowered, as long as the goals are the best care for the patients, who are part of the team and also participate in those decisions.

The Pennsylvania Medical Society has recognized a need to help physicians better cultivate medical teams. As a result, we started the online CME publication Converge and began a year-round Leadership Academy.

We also seek ideas for ways to improve. Do you have a well functioning team model? How have you defined your team? Let us know!


  1. Actual quote from a physician when explaining his behavior when I was an insurer medical director and denied insurance authorization for payment.
  2. Actual quotes from physicians when explaining their behavior when readmission charges denied by author when an insurer medical director.

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