Mission: Healing January 25, 2012

PGY 39, Day 208

Take home message: Never ... that's right, NEVER cut corners in health care. The only exception to this rule would be triage in a disaster situation. In that case, resources are allocated to those who are likely to "make it". Surge capacity and disaster preparedness should be a routine part of hospital structure and function, but it generally given lip service and window dressing to save on costs.

Doing the Right Thing: The Right to Do VS the RIght Thing to Do

How many times have you heard or seen the words "I have done nothing wrong" flowing repeatedly from the mouths of those accused of wrong doing? Well, they seem to be fairly common words from my perspective. A Google search today came up with many pages reflecting the frequency of the phrase. Check it out ...

http://www.google.com/search?q=%22I+have+done+nothing+wrong%22&ie=UTF-8&oe=UTF-8&hl=en&client=safari

What are the jokers who spew these words actually saying? My translation is this: "I really don't care what you think, I have no guilt or remorse (I have no conscience), and have not been proven guilty of breaking any law." While it may be a fact that many of these speakers of innocence are not (yet) proven guilty of misbehavior after further scrutiny, or in a court of law, and some may truly be innocent. And, what are they thinking? These folks rarely talk about the thought process that enables them to do things that they have the right to do, or can do, even though they are not doing the right thing. Why the disconnect? No conscience? This common statement of innocence, "I have done nothing wrong", belies the shady behavior that is absolutely wrong, but may be easy to get away with in the dark, or when in a powerful position. If you don't catch them and prove it in the light of day, or in court, they can and do get away with it ... and they will continue their misbehavior till forced by law or others to quit. Hence the need for transparency. I see transparency as a (perhaps poor) substitute for honesty (including intellectual honesty) and integrity, because the later two are so uncommon. In any case, what are these self proclaimed "inocent" people thinking? What kind of examples do these people (in leadership positions) set for the rest of us and for our children? My observations, based upon personal experience, reading and formal training, lead me to several conclusions ... which are simply the start of a long, ongoing conversation on Doing the Right Thing: honesty, integrity and transparency.

To do The Right Thing, or not to do The Right Thing? That is the question. Or, What is the price of your Integrity?

Why is it that so many seem to have difficulty recognizing the difference between right and wrong? Why is this line so blurry? Is it really blurry? Is that a matter of convenience? Is it greed? Why is it that so many seem to think it is OK to do whatever they want, as long as you don't get caught? These are questions that used to perplex me, but not so much any more. The disconnect between word and deed is very common. In fact, this disconnect is so common as to be ordinary, not extraordinary. What is it about? What can be done about it? Let's look a little deeper.

Generally, it is about a lack of personal integrity, and a willingness to cut corners on "the right thing" (ethics, morality and sometimes legality) for personal gain. This is, regrettably, very common. What is the price of your integrity? Will you cut corners to keep your job? When your boss pushes you to do something that you know is not right, are you going to do what he/she says, or risk loosing your job? I have seen this sort of stuff regularly during my years of life and work. Let's look at some examples that I have seen over the years during my medical career.

There is always an "excuse" for the bad behavior!

Example A: Hospital Excuses for Bad and Self Destructive Behavior

Around 1985 there was a malpractice "crisis". In other words, around this time, it became difficult for some physicians to get malpractice insurance. So, when some doctors went "bare", some hospitals went nuts. Driven by fear (self protection) that their own personal assets would be at risk, some hospital administrations and boards refused to change their policies to allow uninsured docs to keep working in their hospitals (wrong) while other hospitals "did the right thing", and changed their policies so that the doctors could continue to care for patients. In this example, "Doing the right thing" benefits the patients and the hospital by allowing patients to be cared for in their own community, and by keeping hospital revenue up to par. So, what is behind the flawed thinking in this case? Fear of personal financial risk originated in the administration and spread to the board of trustees of the "wrong" hospital. So, fear trumped reason and drove the hospital to do the WRONG THING. What else could these "WRONG" hospitals have done? StepWisley(R) and come up with a rational strategic plan for dealing with the problem in cooperation with the physicians.

Example B: Hospital Plunges into Mediocrity to Keep Control; AKA Blowing a Hole in the Bottom of Your Boat to Save the Ship

This is a beauty! Following the malpractice crisis talked about above, the following misbehavior was noted. A hospital administration and Board of Trustees recruited a marginally competent young surgeon from a nearby residency program to lessen the power of the competent, well respected surgeon who routinely filled the hospital with patients. Guess what happened? Young New surgeon (who was an operative from a competing hospital) torpedoed the ship! Ultimately, his efforts failed and he torpedoed himself, but for several months, hospital occupancy was at an all time low. What had been a very busy and well run Non Profit organization was failing, because the Administration and Board of Trustees was unable to work properly, could not support its medical staff and could not accept the proper authority of the medical staff. From that point on, the hospital slipped and ultimately needed a bailout from/merger with a larger hospital about 40 miles away. So, the the local community lost control and quality driven by the local community.

Example C: Department Chairman "cuts corners" and gets away with it

In this example, a Department Chairman walked away from his supervisory role with residents and actually left the hospital while he was supposed to be supervising. This behavior was so outrageous, that it came to the attention of proper authorities. During the investigation that followed, he admitted to "cutting corners" but he was able to slip out of any disciplinary action. How he got out of it, I don't know, but I don't think he ever made that mistake again. The real question is this: How could justify the behavior ... how could he conjure up a thought process that would twist such blatant misbehavior in such a way as to think it was acceptable?

Example D: Hospital Stupified by Y2K ... a prolific excuse for bad behavior among hospital administrators.

This situation was noted when I arrived to take a new position in the Summer of 1999. The preoccupation with Y2K nonsense by hospital administration was so outrageous as to be comical, but it consumed all their energy, and the consequences were not funny. The situation was so bad that we could not get attention for any real front line problems, and that repeatedly put patients at risk. We could not get proper equipment and we could not get the hospital to address any problems. To combat this stupidity, we were forced to take pictures of faulty equipment and we threatened to supply videos to the local TV stations, if they did not take proper action. When the hospital safety officer was presented with our documentation "book" that was prepared for the next JCAH visit, he flipped through it with a stone face and, at the end he said, "Can you loose the pictures?"

Example E: Department Chairman Refuses to Acceopt a Solution to His Problem

Perplexing at best, this guy asked me to help solve a problem that threatened to destroy the integrity of and quality of care in HIS Department. I did the job over several days by working with the entire faculty, came up with a solution acceptable to all and handed it to him in a nice neat package. He then said, "We are not going to do this." Shortly thereafter, he was replaced, and OUR solution has worked smoothly for more than 10 years. What was he thinking?

Example F: Katrina Stories (before, during and after Katrina)

Example G: The "Financial Crisis" Bad behavior today that use the the current financial situation as an excuse

Example H: Department Chairman Doing things "because he can" (get away with it?)

To be continued ...

Mission: Healing January 6, 2012

PGY 39, Day #189

White Dawning

This morning dawns cold and white,
light snow falling.
Flakes float gently through windless gray skies,
forest's green and brown,
landing gently ...
a thin blanket on frozen  ground.
Peering through glass, safely warmed ...
wood stove and hot coffee bring children's laughter,
as they play on my mind ...
catching memories of cool flakes,
melting on my face and tongue.

Have a great day!
Dr. Mike