Thursday, May 28, 2009
Telling the truth
When I began training with the bluntest man I ever met, he said to me," I know you don't know any orthopedics and don't pretend you do.If you want to stay here, there are only two requirements, be on time and don't lie! If you screw up a surgical case , say so. That way you never have to remember what you said. You have an insurer to look after your interests. It's his problem, not yours." The orthopedic service in the 50's in Olympic City was one of the better organized services but the system was run like a military establishment and you obeyed orders or you didn't survive. There was little room for free spirits and no room for sluggards. If you had a family and children and your wife needed a little down time with you, it was a task to escape the taskmaster. We probably would have been better to have adopted a celibate monkish existence for the training period of five years. How the pianist ever survived that period of neglect is a wonder. The Chief, at the end of each training year, told you where you were to go the next year. No one ever said no. Unfortunately I did as my putative year was to be a traveling year. I had 2 children and a wife and no money. I said I couldn't do it. I went from golden haired, to close to persona non grata! Senior surgeons came up and upbraided me for daring to say no to the Chief. Even then, as a lowly 2nd year surgical resident I could not get over the willingness of talented senior surgeons also bending to the rule of one man. What's more, as I think of the first interview and the Chief's observation that we don't lie because we don't need to since we can offload the responsibility to the deep pockets of the insurer, I believed, even then, that there are other reasons to be transparent and tell the truth. I can't deny however that having an insurer is handy. I spent 12 years on the College of Physicians and Surgeons adjudicating patient complaints about doctors and the most prominent cause was lack of transparency. If we screw up a case we can be forgiven by most patients, most of the time, if they know we were there for them, on time, and we didn't lie.