Blog | Friday, July 26, 2019

Doctor, stop being so nice (apart from with patients)

The changes that have occurred in health care over the last few years represent a sea change from the autonomy and clout that physicians once had. It's no great secret to anybody working in medicine that most of these changes to practice—including the push towards employment instead of private practice, and the need to now spend the majority of the day clicking boxes on a computer screen—have not been well received by the majority of doctors. Speaking as someone at a relatively early stage of my career, it's impossible not to place a large proportion of the blame on the older generation of physicians, simply because it's impossible for such a large and respected group of professionals to cede so much power so quickly, without a lack of strong leadership being a factor.

Nevertheless, what's happened has happened, and we can only now look to the future to secure not only the best work environment for ourselves, but more importantly, the best for our patients. But there is another factor at play, which is rarely talked about. And that's the fact that so many physicians are simply too nice (and dare I say, even naive). We are in the “zone” of patient care and often suffer “tunnel scientific vision.” We too easily allow ourselves to become cogs in the wheel and jump on board with changes that are being imposed on us. The problem, especially when it comes to dealing with the corporate and business way of thinking (and this goes in any industry) is that you are dealing with very savvy operators, who will run rings around people in a heartbeat if those people allow them to.

Some examples of Doctors being “too nice”:
1. Jumping on board with an administrative directive which may not be the best for patients, in the name of cooperating and being a “good and compliant” doctor. We are used to obliging most requests during the day, and it's difficult to shake out of that mode when we need to.
2. Saying yes to a request to “help” with a certain project or committee without being adequately rewarded for it. Of course, most doctors score highly on the altruistic scale, but that shouldn't mean being a fool either. Does anyone think for one moment that any of the higher levels of corporate executives would ever be doing anything without ensuring they are paid for it?!
3. Acceptance and over-flexibility. When something happens that is clearly not taking health care in the right direction, this should never just be accepted as “the way things are now and we have to be flexible”. What happened to the caricature of the good doctor, on the TV shows and movies we all grew up with—the fearless advocate for their patients?

I am just over a decade into clinical practice, and would certainly say that I've changed a lot myself. That does not mean being disruptive or aggressively confrontational, but does mean standing firm when it comes to the issues one feels strongly about on principle (and I myself have been fortunate enough to learn from lots of colleagues who I've found inspiring over the years). I've often learned the hard way too, through my own mistakes. To give another personal example, not meaning to go completely off course: Due to my non-clinical interests (to fulfill the creative side of me), I go to lots of health care startup and entrepreneurial events, and have met many interesting budding and established entrepreneurs and technological whizz kids.

When I first started meeting these people, lots of them would ask for my “help” as a physician in developing their product. As a doctor who was trained to help people—I would invariably say yes. At first, I found myself doing things such as quickly reviewing their business plan and product, sitting on occasional advisory panels giving them a clinical perspective, and even helping them get health care contacts to sell their products. After doing this a few times, I thought “what the heck am I doing giving away so much free time to these people?!” Many of them were older than me, and clearly heading for great riches. So let me just get this straight in my mind: I help you, give you huge clinical insights, spend time advising you and even getting you contacts—and you make all the money. Sounds like such a fair deal!

I've also had similar situations where people have asked me to write for their blog to help them grow their business. Write regular original articles just for them, with nothing in return. What cheek! Don't get me wrong, I'm always happy and willing to help people here and there, but a regular commitment of my time—no way brother. It's a life lesson many of us learn: there are plenty of folks out there who will keep taking if you offer anything at all. Be nice, give an inch, and a mile is soon taken from you.

I'm convinced that many entrepreneurial and business people get away with this because as physicians, we have the altruistic gene and always want to “help” improve health care and innovate. Nowadays though, whenever I encounter a tech entrepreneur asking for my help, I make it clear that they can either employ me as a consultant or have me on their team formally with a share of the company. Some agree, but lots of them stop contacting me once they realize I'm not working for free!

This is just one example of how my attitude has changed over the years. But I didn't mean to go off on a tangent. When it comes to working as a physician, my days of “helping” administrators in a selfless way are long gone, and experience has taught me that being a nice physician only serves to get you trampled on. The only people that I'll go the extra selfless mile for are my patients. Nobody else. It's something that probably every physician will eventually learn in this environment we find ourselves in. And it's absolutely not just about the money. We are reasonably well compensated professionals. It's more the principle of not being taken advantage of or taken for granted. It's about taking a firm stand when you believe your patients' best interests and good health care are at stake. That's the moment every physician needs to stop being Mr. or Mrs. Nice.

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.