A Matter of Right and Wrong

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.”

Mahatma Gandhi

**When doing wrong feels so right: normalization of deviance

    MR Price, TC Williams – Journal of patient safety, 2018 – journals.lww.com

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Natalie Newman MD

Dr. Natalie Newman is a residency trained, board­certified emergency physician who has been practicing for nearly 24 years. In 1991, she graduated from California State University in Sacramento, California with a degree in Biological Sciences. She then attended medical school at Case Western Reserve University in Cleveland, Ohio on an Army scholarship. As a graduating senior, Dr. Newman was presented with the Marjorie M. and Henry F. Saunders award for her compassionate care of patients within the family structure. After her graduation in 1995, she was accepted into the Emergency Medicine Residency at North Shore University Hospital in Manhasset, New York. Upon her graduation in 1999, Dr. Newman entered active duty service with the U.S. Army. Her first assignment was at Womack Army Medical Center in Fort Bragg, North Carolina. During her stint in the Army, Dr. Newman was deployed to Bosnia­Herzegovina(formerly Yugoslavia) where she was Chief of the Emergency Department at Eagle Base in Tuzla, Bosnia. She had the honor of serving under the command of Colonel Rhonda Cornum(now a retired brigadier general), a urologist, pilot and former prisoner­of­war during the Persian Gulf War. While in Bosnia, and as the only American female physician in the Balkans at that time, Dr. Newman was assigned as the personal physician for Queen Noor of Jordan during a humanitarian visit to a local hospital in Bosnia. After her return home to the U.S., she was promoted to Major and completed the rest of her Army service at Fort Bragg. Dr. Newman subsequently returned home to California where she continues to practice as a traveling physician and participates in multiple speaking engagements about the values of education, of which she is passionate. She is also a member of Physicians for Patient Protection, a patient and physician advocacy organization. 

  10 comments for “A Matter of Right and Wrong

  1. Jennifer Hollywood
    November 12, 2019 at 11:23 am

    CareFirst in my state is pushing for complete access to all patients medical records for all specialties. They are pushing us to sign up with FigMD. FigMD will access our medical records every night and copy to their servers all of our notes and test results for the day. They will then split off CareFirst patient records for CareFirst so that they can access the complete patient chart. CareFirst states that this is to improve billing, authorizations, and HEDIS reporting. But I don’t think that FigMD should have access to ALL my patient records. I also don’t think that a private for profit health insurance company should have unrestricted access to all my CareFirst patient charts. CareFirst and FigMD are saying that this is HIPAA compliant since when you sign up for insurance you agree that the insurance company can have access to your records for payment reasons. But I think this is an inappropriate extension of the law.

    • Natalie Newman, MD
      November 13, 2019 at 1:10 pm

      I agree that is a violation of HIPAA. I have never agreed with that insurance statement that they have access to all records. I think they should only have access to what is pertinent to the visit for which they are paying.

    • R Stuart
      November 13, 2019 at 3:05 pm

      That’s the whole purpose of EMRs.

    • R Stuart
      November 13, 2019 at 3:06 pm

      And what happens if you don’t sign up with FigMD?

      • Jennifer Hollywood
        November 13, 2019 at 3:18 pm

        Currently I get paid slightly less by the insurer if I refuse to sign up with FigMD. I am concerned that in the future, if they receive no push back from anyone, that it might be mandatory for all CareFirst clinicians. Then I would have to choose between getting FigMD or going cash only and dumping CareFirst or joining up with a hospital where the decision is out of my hands. CareFirst insures the majority of insured (non Medicare or Medicaid) patients in this area. So if I left CareFirst I would lose a large proportion of my current patients. Well over half of my current patient panel. My other concern in this entire situation, is that none of the other doctors that I have interacted with regarding this demand seem to find this to be a problem. They are willing to hand over the charts without any worries. I suppose the system has worn them down. They find it harder and harder to see what is right for our patients. On a similar note, Ascension Healthcare just shared it’s patient data with Google. So apparently our medical charts are no longer private.

        • R Stuart
          November 13, 2019 at 4:45 pm

          It’s hard to believe that there are still some MDs so innocent/clueless that they think EMRs have something to do with better patient care.

  2. Pat
    November 11, 2019 at 7:09 pm

    Nice piece Dr. Newman. I think as in so many other walks, that attempting to embrace altruism established a permanent conflict within individual physicians, and within the profession. Better that we should have acknowledged philanthropy as a goal, yet acknowledged that we also needed to recognize self-interest as a valid goal. Our failure to do so has harmed our patients, and rendered medicine a largely dishonest pursuit.

    • Natalie Newman, MD
      November 13, 2019 at 1:12 pm

      Very true.

  3. Bridget Reidy
    November 11, 2019 at 10:12 am

    Thank you. I have lost many jobs. Blacklisting along with lack of recent reference letters almost ended my career. (In many positions nowadays you barely get to know other docs.) All essentially for speaking cautiously and politely for patient care and not committing fraud.

    • Natalie Newman
      November 12, 2019 at 1:03 am

      Yep. Been there. Some physicians believe they have no choice. We do. It’s just that the alternative, that is, doing what one knows to be right in our industry, is difficult. However, difficult does not equate to impossible.

      We don’t forget our integrity…we relinquish it. That is a choice. A bad one.

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