Physicians Meeting the Challenge of Contrasting Ideologies

Excerpted from All Physicians are Leaders: Reflections on Inspiring Change Together for Better Healthcare , by Peter B. Angood (American Association for Physician Leadership, 2020)

Our nation’s healthcare industry is more complex than all other industries and will continue to be complex and create significant uncertainty. Such complexity, interestingly, seems to occur regardless of political leanings or opinions, but this uncertainty means that large numbers of patients and their families are being negatively affected.

Remember: the number one reason why people file for bankruptcy continues to be related to healthcare debt.(1)

Growing up in Midwest North America, I distinctly remember a multitude of societal opinions that often carried distinct bias and deeply engrained ideology. Of course, while I was young, I did not understand these words, let alone the nature of the behaviors they represented. Going through medical school, I gradually became aware of these human attributes and how they impacted not only clinical care but also management decisions that eventually influenced educational approaches. For example, our medical school class was subjected to a unilateral decision that we all had to receive BCG vaccination against tuberculosis. At the time, it was a relatively untested approach of unproven value—and no member of the class was given the option of not receiving the vaccination. Given the nature of our training environment at the time, and the social diversity of patients passing through the system, I still argue that this was not a public health–oriented decision, but one of implicit bias and regional ideology within the leadership of the school.

Behaviors, or actions, are predicated on individual and collective values, beliefs, and ideals. Behaviors influence our cultures and ultimately the environments within which we live, work, and play. Leadership, and the behavior of leaders, is what influences a culture most significantly. Creating a healthy culture is pivotal for improving the healthcare industry, and healthcare leadership must take special care to manage implicit biases and contrasting ideologies through exceptional behavior.

Values, Beliefs, Ideals, and More

Perhaps it’s a bit remedial, but covering a few basic definitions can be a helpful reminder about what drives our behaviors and actions.

• Values: Important and lasting beliefs or ideals shared by the members of a culture about what is good or bad and desirable or undesirable. (Source: Business Dictionary)

• Beliefs: Assumptions and convictions that are held to be true by an individual or a group, regarding concepts, events, people and things. (Source: Business Dictionary)

• Ideals: Persons or things conceived as embodying such a conception, and conforming to such a standard, they are taken as a model for imitation. (Source: Dictionary.com)

• Ideology: A system of ideas that explains and lends legitimacy to actions and beliefs of a social, religious, political, or corporate entity. (Source: Business Dictionary)

• Implicit bias: Refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner. These biases, which encompass both favorable and unfavorable assessments, are activated involuntarily and without an individual’s awareness or intentional control. (Source: Kirwan Institute for the Study of Race and Ethnicity, Ohio State University)

• Consensus: The middle ground in decision-making, between total assent and total disagreement. It depends upon participants having shared values and goals, and on having broad agreement on specific issues and overall direction. It implies everyone accepts and supports the decision, and understands the reasons for making it. (Source: Business Dictionary)

Leadership Is Always About People

Patient care is all about people. Clinical delivery systems are all about teams of people working well together. And the patient–physician relationship remains one of the most intimate, trusted, and caring of human relationships known.

All physicians are leaders at some level, and leadership is ultimately about people—regardless of clinical discipline or nonclinical activity. The leadership that physicians provide, whether informally or formally, is still a dominant influence for the culture of healthcare.

The values, beliefs, and ideals of physician behavior remain central to one of our profession’s sacred guides, the Hippocratic Oath; it is perhaps the most widely known of Greek medical texts. The oath requires physicians to promise to uphold a number of professional ethical standards. Here are a few excerpts:

“In purity and according to divine law will I carry out my life and my art.”

“Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.”

“Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.”

“So long as I maintain this oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time.”

Let us all reinvigorate in consideration of that oath as we seek ways to augment the professionalism that has carried the health and culture of the industry for so many generations. Incoming physicians, and those established in careers, readily gravitate to the altruistic side of the spectrum for these values, beliefs, and ideals. It is our collective altruism that shapes our individual as well as collective behaviors. Altruism can be considered a core ideology for physicians.

The past few decades have challenged physicians’ roles in healthcare and in society as a whole. The recent shift to a value-based model of care delivery is likely to survive and become the predominant focus for care delivery. Compared to the recent past, physicians now have a fresh opportunity to demonstrate leadership at all levels. The opportunity for influence by physicians will help shape the evolving culture of healthcare in coming years. Physicians value “value.”

Adapting for Perpetual Change

The inherent complexity of healthcare creates the perpetual expectation for change. We must all be comfortable with this reality. Even with the variety of value-based approaches on our horizon, significant swings in our industry already are occurring. As another important figure from ancient Greek history, the philosopher Heraclitus, once said, “The only constant is change.” That readily applies to healthcare. The vagaries of national politics contribute to constant change, regardless of which party is in control. Obviously, physicians will have opinions and debates not only on politics in general, but also on the impact of politics on healthcare specifically. In these discussions, contrasting ideologies certainly will surface and, at times, create consternation.

Physicians are positioned to provide balance and direction within healthcare during periods of intense change.

As leaders, physicians also have the opportunity to use their influence to facilitate healthy, balanced discussions while also helping their local, regional, or national environments achieve stability in the face of contrasting ideologies. Again, physicians are leaders, and leaders create culture through their influence—not only in their decisions but also through their individual, daily behaviors. Physician-oriented values, beliefs, and ideals can provide the voice of reason when contrasting ideologies are present. Where change is constant, leadership also should be constant—to provide the optimal pathway through shifting circumstances. Physicians are positioned to provide balance and direction within healthcare during periods of intense change. Let us all rise to the occasion and not become excessively distracted by contrasting ideologies. (To quote another popular phrase: “May the Force be with you.”)

While pursuing my academic career in trauma surgery, followed now by more than a decade of leadership roles nationally and internationally, I have come to realize that contrasting ideologies are always active on a routine basis. The implicit biases that are related to them create the diversity of opinion that ultimately makes our world so special. Navigating ideology and implicit bias are a portion of my daily routine. In so doing, I must always be introspective and on an internal lookout for how my own implicit bias may (or may not) create decisions that are not fully optimal.

To help offset my propensity of implicit bias and ideology, I routinely seek a variety of opinions from a variety of sources that I know will not be similar to mine. I believe this is what successful leaders should do in order to make their best decisions, regardless of leadership style. Building consensus becomes simpler and decision-making more robust.

Coming from a background in surgery, it has been an interesting process to continually unlearn my inherently developed surgical personality traits . . . and it is an ongoing process, believe me!

Helping to proactively manage transitions in our industry is a critical component of our professional responsibility; in fact, it has been a professional responsibility since our beginnings.

Reference

1. Himmelstein DU, Lawless RM, Thorne D, Foohey P, Woolhandler S. Medical bankruptcy: still common despite the Affordable Care Act. Am J Public Health. 2019;109:431-433. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2018.304901 .