A curious undergraduate asks below,
Dear Wise elders,
In trying to decide on a career path, I am always struggling with the question of "doing the right thing".
As people in leadership positions, which I think many of the readers here are.... What does it mean to be doing the right thing for your profession/industry/work? I know it's a big question... any thoughts or guidance is greatly appreciated.
I assume the question is not about what specific profession to enter. This is more a question about what ethical, moral, or leadership decisions you make in your professional life. I think the answer is pretty simple: Don't do anything you wouldn't want to explain to your mother. Or to put it more positively, do the things that would make your mother proud.
I am not being facetious or simplistic.
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I remember in 1990 or thereabouts, when Warren Buffett temporarily took over as CEO of Salomon Brothers in the aftermath of a Treasury securities bidding scandal, he brought the senior people together and delivered the following message (I'm paraphrasing): If you lose money for the Firm, I'll be very understanding. If you lose reputation, I'll be ruthless.
My own rule, which I'm sure is common throughout most industries, is don't do anything that would embarrass either myself or my employer if it appeared on the front page of the NY Times or other major newspaper.
Dear curious undergrad,
As someone who recently faced the chance that his life was ending soon, my answer on this is different from what it might have been earlier.
I'd start by being sure you know who *you* are: what unique perceptions, skills, and loves you bring to the human race. If you're clear about those, then struggle tends to fade away.
Second, I'll add something to Paul's excellent remark about making Mom proud. There's a catch: sometimes people think they cannot be themselves because Mom wants them to do something else. ("My son the doctor" comes to mind!)
Finally, when you've found your spiritual home in life, doing the right thing will be much easier. For me, it means contributing excellence (doing the best I can), serving others, and leaving my job (and the world) a better place than it was before I arrived.
p.s. I appear to no longer be facing the chance of immediate death. So I'm especially grateful for the set of people at Paul's hospital who contributed their excellence. They have certainly left *my* part of the world better than before they arrived.
This reminds me of one Family Practice's study of medical error, which succintly (and I think quite nicely) defined medical error as "something that should not happen in my practice, and I don’t want it to happen again." Perfect? no, but a good general rule-of-thumb, much like your answer :).
I’ve distributed bookmarks, with the following quote, at healthcare conferences across the US in memory of my son, Justin.
Integrity
“The highest courage is to dare to be yourself in the face of adversity.
Choosing right over wrong, ethics over convenience.
And truth over popularity…these are the choices that measure your life.
Travel the path of integrity without looking back.
For there is never a wrong time to do the right thing.”
~unknown
I am struck by your answer to the question - it's how I choose to live, and how I hope to live out my career as a medical professional. Still, though, I think making mom proud is hard. For instance, I've chosen a profession where even as a student, I feel the influence of the pharmaceutical industry. I won't cite the literature on this here, but evidence of the effectiveness of their marketing to physicians is easy to come by.
The drug companies are everywhere. We write our orders with pens that say Viagra. Our lunches are funded by Pfizer. The department attends fancy dinners on the drug company dime, while the residents have drinks at the local bar with the drug rep. It would be easy to say that I refuse to take part in what I see as profession-wide violation of ethics, but it's hard. This is a hierarchical profession, and I value the time I can spend with the attendings, and the residents, building camraderie and networking. It seems that so often, that time is bought by drug companies. I wish it weren't so - if I don't start now to behave as a professional, when will I start?
I went to a lecture/dinner recently at a very fancy local restaurant that was funded by a well-known drug company. I sat next to the head of my department - I felt awkward not eating, so I ordered, and then discretely paid for my own meal. I felt good about my decision to opt out, but that was the more expensive route. My other options are to not attend these meetings, foregoing the dinner and the opportunity to make myself a part of the "team", or to accept the dinner, and compromise my principles.
Ideally, such an ethical dilemma would never exist. But that's not the case here. I've been a life-long activist, and am not afraid to advocate for change, but here, I'm not in a position to make waves, not as the low woman on the totem pole, and not when my future depends on the good regard and recommendation of these attendings, who I largely respect and admire.
I'm telling you, making mom proud - not easy. In a situation like this, what would your advice to the medical student be? And what do you, as a hospital CEO, see as your role in helping us to confront this ethical dilemma?
As a caregiver to patients, specifically those desiring elective surgery, I find that "the right thing" often seems to have a spin. How does the media perceive it? What do the lawyers say? What is my perception of the situation? Am I judging (cardinal sin)in any way? Is the patient telling me the whole truth, and if I have an inkling of suspicion should I document it? If I dont, then what? Daily decisions with regard to patient care juxtapose the subjective and objective, and you just pray that you do the best of your ability based on what you assess. I have gone many a nights worrying, did I give the patient what they needed? Did I consider everything? Am I "talking them into elective surgery?" In the end, I answer to only myself to which I ask, Is this the way I would have wanted to be cared for or treated?
Excellent comments all, but I most agree with ohio medical student in that, in modern health care, one's concept of what the right thing IS can be perverted without even realizing it. I find this most difficult in the area of conflict of interest - recognizing it when you see it, and acting on it or speaking up about it - no matter how others may think you are foolish, a crusader, unnecessarily strict, a prude, whatever. Always use Paul's rule, or Barry's rule, or some rule, before you go along with something that others say "everyone else does."
ps Patient Dave; I am delighted to hear your good news; you have my continued best wishes.
The insights into the penetration of US hospitals by pharma reps in Ohio's post are fascinating.
So Heather Locklear's character in Season Two of Scrubs is based on truth!!
(Posted from a small country that pharma seems to care little about.)
I agree with Paul on what the right thing to do is.
I am extremely happy to hear that Patient Dave is getting better :) Way to go Dave!
This will be in response to ohio medical student. I read this post on Kevin MD (www.kevinmd.com) a while ago. You might think about this doctor's solution to dealing with drug reps. To me this looks like the right thing to do:
http://www.kevinmd.com/blog/2007/04/avoiding-drug-companies-and-their.html
In my profession as a contract manager for a healthcare facility avoiding a conflict of interest is 'doing the right thing.' For example if a company buys me a car and I sign a contract with them that would be unethical. But above and beyond the obvious conflicts of interest; even doing anything that can be remotely perceived as a conflict of interest is unethical for me, regardless of if it's actually happened or not.
So be good curious undergrad, and dont do anything that might even remotely look like your up to something 'bad'
As John Kotter taught me in one of his books, you can learn how to be a great leader from both good and bad examples. So here are some examples on the subject of doing the right things:
Bad examples --
Richard Scott, Columbia/HCA
Richard Scrushy, HealthSouth
Good examples --
Jack Bovender, HCA. He did a great job cleaning up Mr. Scott's mess.
Long time ago I learned the following:
Ethics and Honesty are measured by what you do or say when others are not watching.
If you are asked to do something and you can't look yourself in the mirror if you do it. It's probably not the right thing to do.
And finally, admitting when you make a mistake.
Mary Lu
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