When most of us were pre-med students, we were incredibly motivated to succeed. We aggressively, and single-mindedly, pursued our objective of becoming physicians. We allowed nothing, and I do mean nothing, to stand in our way. Regardless of socioeconomic status, gender, religion, citizenship, race, etc., we all shared a commonality….we were driven to achieve an honorable goal. To use the vernacular, “no one could tell us nuthin’”.
That intense drive continued through medical school and residency. Reading and/or studying voraciously, before, after and during our management of patients. Incredibly absorbent sponges we were–for knowledge and application of that knowledge. Sometime during this process, something changed. Still determined to succeed academically and clinically, a slow, internal metamorphosis began to occur…A progressive deflation of our essence. Our being. Our sense of right and wrong, instilled by our parents/guardians/mentors, became hazy. This deterioration of our moral integrity was initiated by the periodic humiliation of those entrusted with our medical education, continuing an unwanted and unwarranted legacy of abuse. These malignant individuals wanted to ensure we remained humble and compliant, deciding it was their duty to enforce this mindset on fully grown, responsible, intelligent adults as if we were children. And their selfish(selfless perhaps?) behavior forever tainting what should have been a positive, momentous experience in our lives, because they lacked the ability to challenge the status quo. Combined with an almost persistent exhaustion, the acts of these individuals set the foundation for that which would eventually make us malleable fodder for more abuse. For those like myself, who were fortunate enough to attend very supportive medical schools and residencies with attendings and professors invested in our education and well-being, let’s just say we were in for a rude awakening when we entered the real world.
Enter the business of medicine. It is illegal for a corporation to tell a physician how to practice medicine. But they do it anyway, sometimes in subtle ways, sometimes not. At times they use physician or nurse flunkies in positions of leadership to do their bidding. These individuals follow orders because they do not wish to lose their jobs/positions. Some of them are the aforementioned malignant individuals from medical school and residency who have now been promoted. Being despicable creatures is their way of life, and they proudly continue the trend. Subservient, but conscientious physicians, doing their best to honor their oath, are forced to make decisions that are incongruous with their ethics. Primed by the toxicity of their educational environment to be acquiescent, they do it to keep their jobs. They have learned to be pliant. And this is where I take issue with my colleagues. Who decides where the line in the sand is drawn? I say it is us, and ethics is the very clear line that should not be crossed. Even if it means losing one’s job. We cannot turn our heads to wrongness. We must not condone substandard practices. We should not allow our fear of becoming unemployed to be the litmus test as to whether we will compromise our principles…or not. Many of us do because we have been molded and emotionally/psychologically beaten into docility. Nevertheless, it is imperative we remain cognizant of “normalization of deviance”. A phenomenon coined by sociologist Diane Vaughan after the space shuttle Challenger accident in 1986. Described “as occurring when people within an organization become so insensitive to deviant practice that it no longer feels wrong.”**, it results in a justification of the unjustifiable. A tacit acceptance of risky or unsafe convention as a result of environmental pressures within the workplace.
I sincerely believe that the great majority of physicians entered medicine for altruistic reasons. No one expected the medical culture to morph into the shambles it is today. As with change in any industry, one must learn to conform a bit. However, that adherence to a new standard should not require one to violate his or her own moral compass. Put simply, do not comply with inferior practices if it compromises the health and safety of our patients. If we permit our moral code to be breached, then what do we have left that is of value?
“In matters of conscience, the law of the majority has no place.”
MR Price, TC Williams – Journal of patient safety, 2018 – journals.lww.com