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Silence is Golden – Electroplated, but Golden

My initiation into the fraternity of doctors included a steak dinner at a local hospital, a pep talk on joining the local professional association, and a private meeting in the doctor’s parking lot – all on the same fateful night.

The steak dinner was one of the tastiest forms of bribery a starving student can imagine, a foretaste of just one of the perks you get for admitting patients to the hospital: a private chef who caters to admitting doctors; a 5-star menu with no tipping required (a doctor’s dream). While doctors dined, their Mercedes, Lexus, and Bentleys are detailed, fluffed and buffed on the outside, and vacuumed and sprayed with new car scent on the inside by hospital valets. Meanwhile, patients and visitors had to park on the fifth level of the garage (if they were lucky to find a spot), settle for cafeteria-style food prepared in large vats, salad bars that consisted of iceberg lettuce and three kinds of Jello. I didn’t do a lot of surgery and I rode a motorcycle, but I still benefited from some of the perks when I assisted other doctors.

The pep talk on the importance of joining the local chapter of a professional association was described as the best way to remain in good standing with your colleagues, a card-carrying member of the good ‘ol boy’s club. I had student loans and start up expenses, so I couldn’t afford the hefty membership dues. Hence, I was on my own years later, defending myself against serious charges of aiding and abetting the practice of an unlicensed physician, a recent graduate who passed the boards but neglected to inform me that he hadn’t paid his state license fees yet. I didn’t know it at the time, but another doctor in town knew about it, and my failure to “inspect instead of expect” my newly-hired’s credentials, and he decided to inform the state board instead of me. An old African proverb says, “If you want to go fast, go alone; if you want to go far, go together.” I would modify the proverb for that night at the hospital when I was initiated into the fraternity of doctors, saying, “Go alone to go fast, but also join your local, state and national professional associations to go far.”

It was the night cap in the doctor’s parking lot that really opened my eyes to the secret life of my colleagues. The private meeting in the doctor’s parking lot was conducted behind the open trunk of a Bentley. The trunk contained a treasure trove of counterfeit jewelry, fake designer watches and electroplated gold chains. Another resident bought a fake “Rolex” for himself and a fake “Piaget” for me. “To look like a doctor,” the owner of the Bentley said, “you need to wear this watch instead of a cheapo Timex.” An hour later, I took it off because the chintzy metal band pinched the hairs on my wrist.

Professionalism demands the caregiver respect himself or herself, the profession and the patient, and I have always abided by this triple standard, putting the interest of the patient and the profession above my own. Yet, I often revisit the memory of that night at the hospital, not to judge or condemn anyone except myself. Medical ethics demands more than knowing the difference between right and wrong. Medical ethics demands more than making the right choices in your practice. Medical ethics demands speaking out in order to inhibit the unprofessional behavior that may go on around you. I said and did nothing about the unethical and unprofessional things I witnessed that night. I turned a blind eye and remained silent out of the fear of jeopardizing my livelihood. Shame on me!

Now, I teach medial ethics and professionalism, and try to foster the courage and bravery it takes for health professionals to police each other. Remaining silent is being complicit, aiding and abetting unprofessional attitudes, behaviors and discriminatory policies. But, “Don’t worry about your job, worry about your integrity,” is easier said than done. I know first hand about the fear to speak up because of job security or a sense of loyalty, but now I warn students and colleagues who think they can practice ethics while wearing blinders to be prepared to accept the shame that creeps up on you years later for remaining silent. Silence may be golden, but it is an electroplated golden that wears off in time, revealing the counterfeit. If you have the courage to speak out against individual misconduct and system-wide injustice, you may take a licking, but you’ll keep on ticking!

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