Arrogance, Incompetence and Cynicism: Bush and Those “Hated” Doctors
Joe Klein in the April 16th 2007 issue of Time Magazine in his Commentary section dissected the behavior (or should I say misbehavior) of President Bush and his Administration and for which Bush is solely responsible (“the buck stops here”). I was struck not only about the validity of the analysis about Bush but also that, by golly, the same analysis could be made about those “hated” physicians that my visitors are writing about in the various threads on my blog .
Klein writes that the mechanism of the collapse of the Bush Administration is centered in three qualities: arrogance (the decision to “surge” in Iraq similar to the motivation to initiate the Iraq war),incompetence (the recent Walter Reed Hospital and the long term care of the disabled American troops issue) and cynicism (in the removal of the U.S. Attorneys). Read the whole article in Time.
In the medical profession, arrogance equals paternalism: “As your doctor, I know more about you than you do and therefore you should do what I say.”. Incompetence equals not taking time or interest to understand the patient, examine the patient adequately and perform properly other professional duties for the patient. And finally cynicism equals having distrust regarding the ethical basis for the profession of medicine and in view of that distrust therefore behaving unethically.
It seems to me that as with our President Bush, self-interest is behind all these three unproductive and destructive qualities. Bush’s arrogance may have resulted from self-interest. Klein suggests that rationale for the invasion was to payback Saddam for the attempt on his father’s life. I think it also obvious that Bush has self-interest to see that his war in Iraq is won to preserve something uplifting in his own legacy thus keep the war going until it is won. I wonder if his attempt to strengthen his own political stature and that of his party along with making an effort to preserve his relationships to his friends in the Administration caused distractions in management and supervision and the resulting incompetence and cynicism that Klein describes.
Those “hated” physicians are those who are not working for their patients but actually are working for themselves and obviously patients easily sense that attitude.. What can we do about all this? Elect a President who cares for the people more than for him/herself and find a doctor who intends to keep the patient’s trust by acting in the patient’s interest rather than his or her own. Do you think that finding a President or a physician who meets that goal is almost impossible? ..Maurice.
posted by Maurice Bernstein, M.D. @ 9:22:00 PM
5 comments
5 Comments:
Maurice - I'm not sure that the problem with people who seem not to take fiduciary duties seriously is a combination of arrogance, incompetence and cynicism. Maybe these character traits do come into play, but I suspect that they are symptoms of a deeper pathology -- the corruption associated with power. Both presidents and physicians seem to have problems not being corrupted by the power _we_ place in their hands.
So Bob, what is the solution? Can we deminish the power by more diligent oversight by independent, trained observers who have the responsibility simply to reign in those individuals whose power might corrupt? Is oversight and appropriate, prompt penalazation, the treatment? Would then someone (the President or those "hated" doctors) simply respond by saying those independent, trained observers are the ones who have too much power? ..Maurice.
Maurice - Although I doubt that there is any general solution to the problem(s) of power, there's a reason I emphasized that '_we_' give power to those who then wield it over us.
First, we should not give powers to others that they don't need to properly do their jobs. I think in the early days of bioethics, great strides were made in educating people about how they can retain the power to make decisions about their healthcare. Even where the physician's expert knowledge looms large, it is usually best to _share_ power rather than cede all to the expert.
Second, since as just noted, it is prudent to cede _some_ power to physicians in light of their specialized knowledge and skills, we also need to be "ever vigilant" about how that power is used. We need to be ready to challenge the decisions of those whom we have empowered, and be ready to retract that power when it seems to be used in ways we have not endorsed.
The checks and balances in the Constitution should protect us from the excesses of the President. Included would be the ability of our legislature to impeach and the voters ability to deny a second term. Why don't they always work?
For the physician, it would be the state regulations regarding the practice of medicine, hopefully through an "ever vigilant" state medical boards. But this requires the input of concerns to the boards by other physicians and patients. Finally, it would be by patients refusing to return to a rogue physician.
I suppose that any appropriate and required powers society gives to the President and doctors can be used by the individual in inappropriate fashions and to deny those appropriate powers would be "to cut off our nose to spite our face."
It's a complicated business to keep those in power (doctors and Presidents) on the straight and narrow. ..Maurice.
I don't think the situations are exactly analogous. The pursuit and exercise of political power through government has a lot of structural and incentive problems, among other issues, and is really not amenable to control by the people it's supposed to serve (the Constitution has failed to check many of the abuses of government power). I believe the pursuit, gain and exercise of power is inherently corrupting and difficult to control, and the best way to avoid abuse is to avoid putting great amounts of power over others into the hands of a single individual. Power, in order to be controlled, needs to be diffuse, not centralized.
That said, I think that people who take part in government and (some) doctors have one thing in common: the belief that individuals are poorly suited to make important decisions for themselves, and that the power to make vital decisions is best taken out of their hands and given to "experts" or "objective" individuals (a good example of this is the way the FDA operates). You end up then havign layers and layers of experts reviewing the decisions of experts, ultimately making important personal decisions for people they've never met and know nothing about. People have an easy time believing that the "right" or "rational" course of action is "what I would have done myself under the same circumstances." They then believe that institutional structures are necessary to make sure that people either make the correct decisions or have them made for them. Often this is driven by the genuine pain that some people feel at seeing others make decisions that they think are incorrect or harmful. They end up thinking that it's acceptable to go to any lengths to keep people from making "bad" decisions. Just look, for example, at the lengths we go to to keep peaceful, law abiding individuals from using marijuana, or the difficulty chronic pain patients have getting relief, because some individuals become addicted to mind altering substances when given access to them. Beliefs like this lead to the idea that it's ok to treat competent adults like children and take their decision-making power away from them, or limit the choices they are allowed to make for themselves. Of course, once you place decision making power over others into someone's hands, it's ripe for both outright abuse and bad decision making due to incentive problems. The answer is to place the maximum amount of decision making power for an indivdual in the hands of that individual. That prevents others, be they bad doctors or rotten politicians, from using their power over others for ill.
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