COMMENTARY

Why Doctors Need to Be Gutsy

Michael Langan, MD

Disclosures

January 11, 2017

In This Article

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Most Doctors Have a Moral Compass

The majority of doctors are of good heart and sound mind. Most doctors strive to do the right and correct thing to the best of their capabilities in any circumstance. Most doctors are by nature are intelligent, inquisitive, and caring. Their actions are driven not by self-interest or greed, but by thoughtful reasoning and moral compass.

As in any population, of course, vast differences exist in individual characteristics, including intellectual acumen, empathy, and common sense. Those bereft of moral compass and the intolerant and prejudiced walk among us in all professions. Medicine is no exception.

The simple truth to the matter is that the overwhelming majority of people are good people. They are honest, have integrity, and are guided by conscience. Most police officers are not trigger-happy racists. Most priests do not have an affinity for altar boys. And most doctors do not hand out opiates like Halloween candy. What we hear about are the exceptions, not the rule.

John Forbes Nash, Jr, was an American mathematician who made fundamental contributions to differential geometry and game theory and was portrayed by Russel Crowe in the 2001 film A Beautiful Mind. Nash described a type of equilibrium in which these harmful exceptions were kept at bay by the population majority with empathy and reasoning. This small minority of the population was kept in check by countermeasures. Miscreant actions were met with law and other measures that provided consequences for actions outside societal norms. Thus, self-serving actions that are in one's best interest but performed at the expense of others are stifled and prevented from gaining a foothold in the majority population.

In regard to the medical profession, an apt example of Nash equilibrium is the case of Detroit doctor Farid Fata, who devised a scam to diagnose cancer in patients who did not in fact have cancer, to profit from the unneeded treatment. This was an unconscionable scheme incomprehensible to those of ethical integrity. His pocket was lined with $34 million over the years.[1] When Fata was eventually caught, the federal prosecutor recommended a 175- year prison sentence owing to his egregious acts, and he was sentenced to 45 years in prison.[2]

Although someone contemplating a risk/benefit analysis of diagnosing healthy patients with cancer as a means to put coins in their purse is undoubtedly a rare event, the severe consequences of Fata's actions serve as a deterrent. Criminal reasoning also uses a risk/benefit analysis regarding the chances and consequences of getting caught.

What might Nash say if, individually and collectively, this same population was put in a position of power over others but without any oversight, regulation or accountability? A disequilibrium would inevitably ensue, with grave complications for the rest.

When Reality Becomes Ominous

Coraline is a children's novella written by the British author Neil Gaiman in 2002. It has been compared to Lewis Carroll's Alice's Adventures in Wonderland and was adapted into a film in 2009.

Coraline is a little girl who moves into a new house with her parents. She is constantly bored and unhappy because her parents do not give her the attention she wants. While exploring the house, she finds a door that leads to an alternate version of her reality, where her parents are fun and attentive and everything seems wonderful.

But things get creepy very quickly. Her parents look like her parents, but where their eyes should be, they have shiny black buttons. Coraline soon finds herself in a horrific, dark place that looks like reality but is slightly off and terribly ominous and threatening.

Such is the case with the medical profession today. Somewhere along the line, it took a nasty left turn. Although it looks the same, its slightly off nature has become threatening and crippling. There has been an erosion in the hierarchy, and much of the practice and policy pushed by the regulators and administrators is absurd.

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