Speak Truth to Power

One of the unexpected, and inspiring, outcomes of the tragic shootings in Parkland, Florida has been how the students have become the leading voices in the #NeverAgain movement.  Like those involved in the #MeToo movement, they are proving that victims do not have to stay victims, do not have to stay silent, and do not have to wait for "experts" or politicians to get around to action.

More people in healthcare need to "speak truth to power" as well.

One need look no further than the Larry Nassar scandal.  He managed to abuse hundreds of young athletes, including prominent Olympians, for decades, seemingly under the radar of his medical practice, his university, and USA Gymnastics, to name a few.  There had been complaints, or at least questions, about what he was doing for many years, but not until The Indianapolis Star reported on it in 2016 was action taken.

Dr. Nassar is going to spend the rest of his life in prison, but we have to ask: who knew?  Who should have known?  Why didn't they speak up sooner, or investigate more thoroughly?   Dr. Nassar was responsible for his own actions, but many people should be asking themselves what they could have done.

Not everything is as clear-cut as that.  For example, The New York Times just reported on how "gag clauses" from pharmacy benefit managers (PBMs) prevent pharmacists from discussing the "real" price of prescriptions with consumers, such as when having insurance perversely costs them more.  PBMs say the practice is not condoned and is, at most, "an outlier," but pharmacists disagree.

And, as Elisabeth Rosenthal pointed out in An American Sickness, such clauses aren't limited to pharmacists.  Doctors and people working in hospitals or other health care settings have been, and may still be, subject to them.

Gag clauses may be good for revenues, but not for customers.  Who didn't object to signing an agreement with one?  Who didn't object to asking for one?  Who didn't speak up?

They're hopefully not as prevalent as they once where, but even without them, try having a conversation with someone in, say, a healthcare billing office about their pricing, and just see how far you get.  Gagged or not, their billing practices are not something they want to discuss.

I'll make this bold statement: everyone who works in healthcare has seen or been part of something they are, at best, not quite comfortable with.  Maybe not illegal, maybe not even strictly unethical, but something that doesn't sit quite right.  How many of us have spoken up about them?  How strongly?

Maybe it is doing procedures on patients that they don't really need.  Maybe it is charging them eye-opening amounts of money.  Maybe it is sending patients to collections because they can't pay those amounts.  Maybe it is double and triple booking patients, making them wait for hours.  Maybe it is waking hospital patients up in the middle of the night for tests that, really, could wait until the morning.  Maybe it is knowing that doctor whose memory is bad or whose hands are shaky. 

We tell ourselves that it is all for the best, that we're just doing what we're "supposed" to, and that the people in charge know what they're doing.

Tell that to the kids from Parkland. 

Rich Joseph, a resident at Brigham and Women's Hospital, wrote a thoughtful op-ed with the scathing title Doctors, Revolt.  He cites an example of an elderly patient who complained about being poked and prodded.  Dr. Joseph indicated he understood his frustration and said he wished he could do something. 

The patient, who was himself a physician, was blunt in his response: "Understanding is not enough.  You should be doing something to fix the system."  The elderly patient-physician later further urged him: "'doctors of conscience' have to 'resist the industrialization of their profession.'"

It's not just doctors and it's not just "industrialization.  Whether we're physicians, other health care professionals and workers, or just patients, we all need to have a conscience.  We all need to do what we can to fix the system. 

We need to resist, and speak up, whenever we see things in healthcare that just aren't right, where we or others are not being treated right. 

Don't get me wrong; this is not a problem just limited to health care.  The Wall Street Journal recently discussed the "success theater" at GE that has led to masking core problems.  One analyst said: "The history of GE is to selectively only provide positive information."  A consultant who knows GE well added, "GE itself has never been a culture where people can say, ‘I can’t.’”

Much less, "we shouldn't."

In a related story, Robert Bies, a professor at Georgetown university, told The Washington Post,

It's more common than you think.  With GE's 'success theater,' the stakes are so high. But every organization you’re a part of, there’s a challenge to being forthright and honest.

The Post article also cites advice from Andy Grove, Intel's founder, to "embrace the discomfort," and urging leaders "you've got to make it more uncomfortable for people to say nothing than to say something."

It's not just GE -- truly, it's every business and every organization -- but the stakes in health care make speaking up all that much more important.

Medical television shows like The Resident, House, E.R., or even Grey's Anatomy are popular in part because the heroes break the rules.  They question authority, they challenge the bureaucrats, and they always look out first for the patients.  They're following Dr. Joseph's admonition to revolt. 

Maybe, though, what we need is not so much revolt as making sure those stupid rules, those not-patient-friendly practices, don't exist at all.  We need more people who don't just want to break those rules, but to change them into something better. 

After all, we don't want an ad hoc healthcare system, where there are no rules and every situation is a one-off, but we do want one that doesn't keep putting rules over patient needs.  We do want one where people speak up when they see things they don't think are right, and keep speaking up until they are. 

If those kids from Parkland can speak up so boldly and so eloquently after having been shot or having friends that were shot, then who among us are too timid to speak up about what we see wrong in our healthcare system?