Why is it so hard to do the right thing?
We have a crisis in entrepreneurial character. and doctors are not exempt. Justifiable suspicions of physician entrepreneurs result when the halo is cast over the profession by those who commit fraud, double-deal, or don’t prioritize the patient’s interest above others. They can’t reconcile the ethics of medicine with the ethics of business.
The hall of shame adds new members on an almost daily basis, including doctors defrauding Medicare,physician entrepreneurs cutting corners or misreprenting data to satisfy investors and shareholders or “pill pushing”. Add Theranos to the list.
These leading medical figures are among dozens of doctors who have failed in recent years to report their financial relationships with pharmaceutical and health care companies when their studies are published in medical journals, according to a review by The New York Times and ProPublica and data from other recent research.
The World Medical Association (WMA) first adopted the Declaration of Geneva in 1948 as the contemporary successor to the 2,500-year-old Hippocratic Oath. Since then, just minimal amendments were made. But in October—after two years of gathering feedback from WMA member national medical associations, external experts and the public—the WMA adopted the revised Declaration of Geneva at its General Assembly meeting in Chicago.
In addition to the declaration’s being called “The Physician’s Pledge” for the first time, the policy:
- References respecting the autonomy and dignity of the patient, which was not previously recognized in the declaration.
- Adds that the “well-being” of a patient will be a physician’s first consideration, amending a clause to state that the “health and well-being of my patient will be my first consideration.”
- Creates an obligation for respect between teachers, colleagues and students. Previously, it called for students to respect their teachers, but included no reciprocity.
- Establishes an obligation for physicians to share medical knowledge for the benefit of their patients and the advancement of health care.
- Requires physicians to attend to their own health, well-being and ability so they can provide the highest standard of care. This comes at a time when physicians have seen an increase in workload and a rise in occupational stress.
- Augments an existing clause that calls for a physician to practice with conscience and dignity by having physicians pledge to practice with conscience and dignity “in accordance with good medical practice.” This was done to more explicitly invoke the standards of ethical and professional conduct that patients and physicians’ peers expect.
The problem is obviously not new. Why is it so hard to do the right thing?
1. People are inherently flawed, “broken branches” and turn a blind eye to their foibles
2. The world is getting more complicated with intertwined conflicts of interest that often fall in the grey zone
3. Society has become more permissive
4. People think they can get away with it. They are often right, particularly when you have power, influence or money.
5. Rules of civility have become more lax
6. A possible decline in self-disiplinary skills and delayed gratification. More and more people choosing the one marshmellow over two later on.
7. A media and communications culture that showcases the Big Me over the Little Me.
8. Pressure from investors and shareholders at the expense of patients because the stakes are getting bigger.
9. A culture of entrepreneurship that fosters an ethos of win at all costs, short term thinking and creating shareholder value at the expense of employees.
10. The differences between the ethics of business and the ethics of medicine.
Despite all this, there are exceptions that display our better angels, like my friend and colleague, John Kelley, CEO of www.cerescan.com, who worked for several high profile execs that eventually went to jail.
Several authors have explained why white collar crime exits, including physical and psychological distance from the victim, pressure , opportunity and rationalization.
- It’s hard to fathom how lying and deceit permeated organizations. Some researchers point to group decision-making processes or psychological traps that snare leaders into justification of unethical choices. Certainly those factors are at play, but they largely explain dishonest behavior at an individual level ,but these four systemic factors influence whether or not people in organizations distort or withhold the truth from one another1) lack of strategic clarity, 2) unjust accountability systems, 3) poor organiozational governance, 4) weak cross-functional collaboration.
The first step in building your capacity to say no is to recognize some common situations that should raise a red flag. Entrepreneurship education is changing. Students must be equipped with the skills to make values-based decisions.
Once you have to make some hard decisions, here are some things to think about.
Doing the right thing means sticking to your core values and practicing emotional intelligence in the business of medicine.
America has sometimes been referred to as the land of second chances, as if every citizen gets a career Mulligan.
Entrepreneurs live in a world of light and darkness. Some choose one over the other. In medicine, taking the wrong path betrays the society and the patients who have entrusted you with their health and the profession that has made you a member.
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