The Ethics and Heart of Accountability

Ask most medical students what attracted them to our profession and they say, “I want to help people.” In fact, one of the tenets of the practice of medicine is Primum Non Nocere - above all, do no harm. So what do we do when we see that a colleague has forgotten that adage?

Perhaps the person’s judgment has become clouded by substance abuse, financial considerations, or factors other than what’s best for the patient. Or maybe they simply see treatment options in a different way than we do. These types of ethical dilemmas are challenging because they pit one of our values against another. We physicians value service to our patients, but we also value autonomy.

Which value should supersede the other? What is our responsibility to our colleagues, our patients and our profession?

The word, profession, was coined in the twelfth century to describe individuals taking vows upon entering a religious order. Today, the word connotes an esteemed occupation requiring special training. If we want medicine to remain a respected profession, our vows must have meaning and be upheld by each of us. This implies we have a duty to review our actions - individually and collectively. If we fail to effectively monitor our actions and guide individuals among us who have strayed from helping patients first and foremost, we may find ourselves being evaluated and judged by others who have less knowledge of the complexities of medical care and perhaps less compassion for the errors in judgment that all of us occasionally make.

But how do we hold these delicate conversations without alienating our colleagues and in a way that allows truth, kindness and benefit to emerge?

Decades of research into communication and its effect on productivity have led the people at Vital Smarts to suggest that we start difficult conversations “with heart.” Before we sit down with our colleague, we can ask ourselves, what do I want – for me, for my colleague, and for our relationship? And if I want those things, how should I act? It’s important to set the stage properly by giving our colleague an idea that we have something serious to discuss, and finding a time and setting that is acceptable and comfortable. Acknowledging our discomfort as well as our intention – to share our feelings and beliefs, arrive at an understanding of the truth, and offer assistance if that is what’s appropriate – help to diminish defensiveness or hurt. If we find that the situation wasn’t what we believed it was, our relationship may become stronger as we emerge united on this issue. If our colleague’s behavior does need adjustment, it may be our concern and support that will provide the courage, strength and incentive to change.

There is no doubt these are difficult discussions. But if we want our profession to thrive and we want to live our lives with integrity, we can lead with compassion for our colleagues so we skillfully hold these important conversations. We just need to summon our courage – our heart – and begin from there.


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