So you concur with
@gonnif arguments?
@mimelim, your thoughts as a practicing physician would be greatly appreciated.
I tried to write responses to people's posts and after writing and re-writing 4-5 posts I gave up. (Maybe I take forum posts a little too seriously
😉) So I'll try to write in a vacuum not agreeing/disagreeing with specific people.
#1 I think that every person in this thread can agree that physicians are held to a higher standard than your average person and almost everyone would agree that the standard is higher than any other profession. The general public puts physicians on a pedestal. What is good enough behavior for the average person or even the average college student is simply not good enough for a physician. We can disagree on whether this is right or wrong. Whether it is a benefit or a curse etc. But, it is a reality.
#2 I also don't think that anyone can dispute that physicians are expected to police themselves to a large degree and we do a terrible job at it. Physicians are given a huge amount of responsibility. We largely don't have people looking over our shoulders day to day. Yes, we are more accountable from a business standpoint to hospital groups and administrators, but when it comes to day to day decisions, if a physician wants wide latitude, they can have it.
#3 I have said this now 3 times in the past week (twice in presentations and once to friends over a board game) and several times on SDN in the past. Physicians are normal humans. They are incredibly self serving and self centered. While many have altruistic tendencies, as a population, they are not particularly altruistic. Rarely do they consider the field as a whole or a sense of responsibility for where we are all headed. Many simply want to make their money, get their prestige, keep their head down and keep chugging. There are plenty of physicians sitting in the room with me right now that would ignore cheating (I've seen them ignore blatant cheating), that would (and have) ignored patient safety issues, that don't speak up when something is off. All with the same excuse, "I don't want to snitch" or "I don't want to meddle". This is not terribly surprising when you accept that physicians are normal humans since normal humans are this way.
#4 Medical school and residency is transformative. An argument can be made that anyone working hard for 7-11 years is going to change considerably, but I don't think that most people would argue that people grow tremendously during this process. However, the core person does not change. The fundamental values do not change. This is why you will find medical students/residents/attendings that do and say things that defy logic and reasoning. This is why you will find people that consider patient safety to be a relatively minor issue.
I'll give you an example. We have (like most hospitals) a way to anonymously report patient safety issues through a web portal. Anyone can use them and they can be used for near misses, bad things that have happened or for really anything. Each report takes about 30-60 seconds to enter in. Anyone in the hospital (nurses, physicians, administrators, janitors etc) can put in a report. Do you know how many patient safety issues are reported by residents? We had 5 in 6 months. This seemed absurdly low, so we tracked over several weekends how many issues would be considered by the lay public and 3rd party physicians to be incidents worth reporting, tracked and acted on. We averaged 14 reports PER weekend for a single service. When you ask residents (and attendings) why they didn't report them, the #1 answer was that it took too much time, but a close #2 was something along the lines of "I don't want to meddle, it's okay, nobody got hurt this time."
Clearly, I am in the minority, but I don't think that this is a good or acceptable culture or environment. This is a personal opinion, but I think that this environment continues to propagate because we fundamentally select for the wrong people in medical school admissions.
#5 To bring this home to this thread. I don't have any judgement about reporting or not reporting. I don't think you are a bad person for not reporting, most people in my experience won't. But, by the same token, trying to make someone out to be a bad person for valuing integrity of a school or system etc is a pretty ****ty thing to do. Trying to shame someone by calling them a "snitch" is a pretty judgemental thing to do. If you see something that you think is wrong, I think that you should report it. Should you crusade and torpedo yourself? No, of course not. Should you target people and try to specifically harm them? No, of course not. Should you expend a lot of time and resources to try to fix it all? No, of course not. But, is it reasonable to spend 5 minutes thinking about something and a minute reporting something that you think is wrong? I think so. I certainly don't think that it makes you a bad person and personally, I think that those are the people that will better serve the medical community in the future.