Over the years I think I have had trouble distinguishing between cowardice and evil. I am now realizing that awful and evil results are often the result of cowardice, not evil intentions, as only the rare individual has evil intentions (most politicians, for instance). Cowards are everywhere. They are in government and in the private sector. They are in industry, energy, medicine and law. Many laws are the result of cowards trying to “buy” protection from the government from their competitors, for instance.
The average physician is no match for the savy hospital administrator or insurance executive. These corporate types are risk takers by nature and often times are taking risks with corporate money (the so-called moral hazard scenario). I have faulted physicians that signed up as hospital employees and have failed in the past to recognize that this compromise is a result of fear, not some failure of character. I believe that the same is true for those signing up for insurance contracts such as HMO’s and other rationing instruments that are horrible arrangements for the physician and the patient. This enrollment is an act of fear or cowardice even though the results are regularly awful and evil.
Some physicians ask the legislator to protect them from someone on their turf. This, too, is an act of fear. Anesthesiologists are notorious for their attacks on nurse anesthetists. Ophthalmologists are always after the optometrists. Otologists are after the audiologists. I could go on and on. The argument is always the same. ”We, the annointed ones, are here to protect the public from those with inadequate training from certain harm/death/you name it.” This is cowardice, pure and simple. If hospitals need “protection” or “certificates of need” to keep the specialty hospitals from competing with them, they are, quite simply, cowards, not evil actors. If surgeons are afraid that their referral base will dry up unless they surrender to the big and powerful hospitals, they are cowards, not evil people. Wimps not devils.
Or does the fearful trait present in so many physicians represent a flaw in their character? I think it represents a flaw in our training. This fear serves to make us short-sighted and poor decision and people managers and incapable of dealing with the hospital administrator types. I throw this blog out there hoping to start a dialogue not so much to be provocative or judgemental.
Let me know what you think.
G. Keith Smith, M.D.
