Mentors Matter November 27, 2023
Fear ruins love
I think it is important for you to know why I am here with you here today. I love medicine. I think it is the most wonderful profession in all of history. It is a rare honor to be able to of-fer a gift of health to others. And when you help a grandmother live better and longer, it is a gift given also to her grandchildren. And I have also found the truth in the paradox that helping to heal others helps you heal yourself. Science is calculating the math of population research; but medicine is the ethical application of that science. Being a physician is apply-ing science ethically. Medicine is an ethical profession.
But you must know that there are physicians who are very worried about getting sued, or of getting in trouble with hospital administrators, or of upsetting what they believe pa-tients want, and so they over-order tests, sometimes completely unnecessary tests so that “they will not get into trouble.” And they do this “bad medicine” even when they know bet-ter medically, but they blame the lawyers, the administrators, the government, the patients or the system for forcing them to do “bad medicine.” This is called attribution error. These physicians are not just “risk adverse” , they are driven by fear.
Fear ignites irrational thinking, just talk to the children of witches in the Salem trials in 17th century Massachusetts. We manipulate truth with bias for our own safety, real or im-agined. Your frontal lobe is a poor manager of your adrenal glands. This kind of boogie-man medicine will harm your patients financially, emotionally, and physically. You hurt other people when your medicine is driven by fear. This is why the Father of Quality Medicine in the US, Avedis Donadedian says that the secret to quality in medicine is love. And fear de-stroys your love and longevity of medicine. Pervasive fear destroys just about everything.
How you choose to deal with legal threats, how you deal with ethical issues, how you choose to deal with administrative and business requirements, are measuring sticks for how you will deal with personal emotions like anxiety, fatigue, and depression. Your ethos is your destiny.
Today, we are talking about Law and Ethics in Medicine which will present different levels of restrictions and codes concerning physician behaviors. And within any restriction or code of behavior, there is the letter of the rule, and there is the spirit of the rule. As part of my job at the teaching faculty here at Kansas COM; I have been given an assignment, and we could call it a rule or duty, though neither a legal or ethical one, to teach for 1:50 minutes on the topic of Law and Ethics in Medicine; and my purpose, my intent, the spirit of my talks to try and prepare you for the real world of medicine in which you will be given many “rules of behavior” some of them legal, and some of them professional ethics, and then a whole host of various rules of behavior that often get wrongly conflated with law and ethics— things like clinical practice guidelines, CMS core measures, hospital protocols, and other physicians who use the term “standard of care” as a behavior weapon without having a single law class in their life. The only thing worse than a physician with a pilot's license is a physician who believes they know the legal profession. You will hear in one way or another on each rotation you take your third and fourth years, the sentiment “It is proba-bly unnecessary but you just got to do it to prevent your ass from being sued.” This my young sisters and brothers, is a statement of fear. We don’t know law. We know, and should practice the best science we know with the best ethical integrity we can gather. Let a physi-cian make your diagnosis; do not let him tell you about how to approach a deposition.
So I am going to try and illustrate in several different ways how to understand the concepts of law and ethics, letter and spirit, not for the primary purpose of “trying not to get sued” but for the primary purpose of keeping you safe in your practice of a type of medicine that you will love—-which Oh by the way, lawyers tell me just happens to be a good way to pre-vent lawsuits.