NOTE: My statements are not necessarily my opinions. I often post point-counterpoint essays in which I strongly take one side of an issue and later counter that with antithetical views. This intellectual exercise helps me see the merit in opposing opinions and augments my creativity.

Not everyone is corruptible

Some of the rife corruption in our federal government can be blamed on a system that tends to educe character flaws in our politicians. I understand how the corrupting influences in Washington can magnify their weaknesses, but as a doctor, I can't fathom why they cannot exercise the same degree of ethical restraint that is expected of physicians.

Doctors must always put the interests of patients and society ahead of their own, even when it is to their detriment. For example, if an uninsured patient comes into the ER with a heart attack or gunshot wound, I must treat that patient even if it means that caring for him will cause me to lose money (see note #1) and be subjected to potentially unlimited medicolegal liability.

I've had patients offer to pay me huge amounts of money for narcotics they didn't need, and I even had a stunningly gorgeous woman offer me her body in exchange for my prescription pad. I didn't go to medical school to become a drug pusher, so I said no.

If I can resist the temptations of a supermodel, why can't politicians always put our interests ahead of theirs? If they don't want to be fettered that way, they should choose another career. Instead, they sanctimoniously tell us that they went to Washington to serve us. And they do: we're #3 on their list, right after #1 (themselves) and #2 (lobbyists with money). And you wonder why the USA is broke?

All of this should come as no surprise to us. Most members of Congress are lawyers—folks who often put “me, myself, and I” ahead of everyone else and every ethical consideration. Considering how doctors have the “put others first” message inculcated into them, I think that our federal government would do a much better job of serving us if it were primarily composed of doctors instead of lawyers. We could solve the healthcare crisis, too—which became a crisis and remains a crisis because politicians want it that way.

Can you guess why?

Politicians use the fear of various crises as a tool to get people to surrender their rights. The fewer rights people have, the more power politicians have—exactly what they crave. Federal politicians have manipulated the American people and our economy to benefit them and to expand their power. We've paid a very heavy price for that exploitation, yet they almost always get off scot-free.

After Illinois Governor Rod Blagojevich was arrested for conspiring to sell or trade the Senate seat vacated by President Obama, a political analyst said on television that “we're all corruptible.”

I disagree. For example, consider the supermodel I mentioned above. Trust me, there is nothing that men want more than women with whiplash-inducing beauty. I wasn't dating anyone at the time she offered to sleep with me in exchange for prescription narcotics, nor had I dated anyone in the preceding two years. Physically, I wanted her about as much as a person wants a glass of water after three days in a hot desert without drinking, but no amount of physical temptation could reverse my “no” decision. Perhaps assuming that her request for drugs might lead me to assume that she had possibly used illegal ones that might heighten her risk of HIV or hepatitis, she was savvy enough to mention that she never used such drugs, assuring me that I could enjoy what she had to offer without contracting any diseases.

She also offered to pay me a surprising amount of money. My answer was still the same: no. This visibly annoyed her, because she couldn't understand how any man could resist her. She was one of those women who are beautiful, cute, and sexy, with an impossibly perfect body, so I could understand why men found her irresistible—something she felt the need to explain to me, after seeing that I wasn't responding to her in the way she wanted. I've had other very attractive female patients make similar offers, but I turned them down, too.

It would have been so easy to “justify” those narcotic prescriptions:

UNETHICAL MD: Are you having back pain? (wink-wink)

BEAUTIFUL DRUG-SEEKING PATIENT: (thinking, “Oh, I know what he's getting at!”) Oh, yes, Doctor. Pain. Bad pain. My back is really hurting!

UNETHICAL MD: In that case, let's not waste any time so I can get in your pants—uh, I mean, provide the pain relief you so clearly need. I bet that you are allergic to Motrin and every NSAID (Non-Steroidal Anti-Inflammatory Drug) in existence, aren't you?

BEAUTIFUL DRUG-SEEKING PATIENT: Yes, Doctor, I am highly allergic to every analgesic that doesn't give me a euphoric buzz. They cause me to break out in acne.

UNETHICAL MD: You mean “hives.”

BEAUTIFUL DRUG-SEEKING PATIENT: Yes, Doctor, hives. I am in so much pain that I can barely think straight. I also have difficulty seeing.

UNETHICAL MD: You mean “difficulty breathing.”

BEAUTIFUL DRUG-SEEKING PATIENT: Yes, Doctor, my throat closes up. I can barely breathe. Actually, my vision is fine. I can see how handsome you are, and I can see that you have no ring on your finger. It would be a shame for a man as smart and handsome as you to spend the evening alone this Friday night. I am a very friendly person, if you know what I mean, and I'd be very grateful if all of my pain is gone (wink-wink), so if you give me oxycodone instead of codeine . . . well, let's just say that we'll both be smiling! If you prescribe lots of pills, I could spend the whole weekend with you, 'cause I wouldn't have to go out searching for another unethical ER doctor—I mean, another doctor who just might be more willing to give me the drugs I want—uh, need for this terrible pain. You know, this is such a small town, you probably don't have a chance to meet many women who are as gorgeous as I am, so it would be such a shame if we didn't get to see one another after this weekend.

UNETHICAL MD: No need to shop around for another doctor. I just read a study which proved beyond a reasonable doubt that slim gorgeous women like you with large breasts have pain that can only be controlled by large doses of potent narcotics. The researchers weren't sure why that is, so they advised further study of your delicious body—uh, this tragic problem, which I am more than willing to do. It's my Hippocratic obligation.

BEAUTIFUL DRUG-SEEKING PATIENT: Oh, Doctor, you're not just handsome and smart, but ethical, too! I think we're going to be together for a long time! By the way, my twin sister has the same back problem I do. We're identical twins, so our bodies are virtually identical. I wouldn't mind sharing you with her if you can help end her terrible suffering, too. It breaks my heart to see her in such agony.

UNETHICAL MD: (thinking, “I've hit the jackpot!”) Of course I'll treat her, too. I am professionally obligated to treat every woman who is smoking hot—uh, every patient who needs me.

There are some things you just don't do, regardless of the inducement. If someone offered you $100 billion to kill your mother, you'd tell him to go jump in a lake. So are we all corruptible? Obviously not. This “everyone has their price” excuse is just a way for people with defective moral compasses to justify their behavior.

Medical students are taught Primum non nocere, a Latin phrase that means First, do no harm. There is no exception for accepting unscrupulous offers from gorgeous women with amazingly hot bodies.

People with the power to influence the lives of others, such as doctors and politicians, have a moral obligation to do what is best for them. Almost all doctors routinely do that, even when they are given temptations that few others could resist. However, many politicians are less scrupulous.

In tracing the roots of the subprime mortgage crisis, I was stunned to find politicians like Barney Frank (D-MA) willing to screw our country in exchange for comparatively infinitesimal amounts of money—on the order of tens of thousands of dollars. In a 2005 op-ed in the Chicago Tribune, David Axelrod, a top advisor to Barack Obama, argued that trading political favors is part of the grease that makes government work. So would government grind to a halt if such favors could be eliminated? No. Our country would still run; in fact, it would run better than ever. If politicians were not so eager to sell their souls, our current crisis would never have happened. Nor would other political crises that cost us a staggering amount of money. They aren't acts of God that we must endure; they are acts of greed that we must end.

Every politician should study what one of my relatives, Chester Arthur, did when he was President of the United States: behave as an exemplary President for all citizens, not as a politician repaying his supporters. Judging by the praise he received from people surprised by how incredibly good he was, Arthur is one of our greatest Presidents. From the Wikipedia: “Author Mark Twain, deeply cynical about politicians, conceded, "It would be hard indeed to better President Arthur's administration."” I discussed President Arthur in another article explaining why I am selling my Sea-doo, Ski-doo, and shed to help a deported person reenter the United States.

Why are politicians so out of touch with their constituents?

An article in the December 2008 issue of Psychological Science revealed that individuals who perceive themselves as more powerful (e.g., politicians) experience less compassion and distress when confronted with suffering in others (e.g., us). In other words, politicians don't really care about us. They don't care if we struggle to pay taxes. They don't care if their endless bureaucracy makes us go postal—as long as they aren't the targets, of course!

The researchers also found that big shots have less desire to get to know “little shots”—us. For the same reason that I don't socialize with the chipmunk in my yard: he is too unimportant to matter much. I do feed him nuts, though. :-)

Interestingly, the lack of concern of big shots for others was not limited to strangers. The researchers found that high-power individuals are more likely to have less compassion and empathy in their interpersonal relationships. That provides insight into why powerful politicians are more likely to cheat on their wives and less likely to give a hoot about it. Do Bill Clinton and John Edwards come to mind?

Politicians want to make us believe that they are connected to us. Bill Clinton told Americans “I feel your pain.” The hell he does; he and his wife inflicted more pain on me than he will ever know—and even if he did, do you think he'd care?

What politicians say and do depends on whether they think cameras are around. For example, during the 2008 Presidential campaign, Barack Obama spoke to a group of wealthy donors in San Francisco. Thinking that his comments were not being recorded, he commented about residents of small towns in Pennsylvania, saying that “they get bitter, and they cling to guns or religion or antipathy toward people who aren't like them or anti-immigrant sentiment or—you know—anti-trade sentiment as a way to explain their frustrations.”

Judging by this statements, and others that he made when he thought that the cameras were off, Obama looks down on small-town people with disdain and condescension. He regards us not with respect, but with contempt. Obama “clings” to his warped perception of country people like me because he understands us as much as we understand how he could choose to associate with his wacky Reverend and the other bizarre people he's known, such as Bill Ayers who admitted “I don't regret setting bombs” in a September 11, 2001 (of all days!) article in The New York Times: No Regrets for a Love Of Explosives; In a Memoir of Sorts, a War Protester Talks of Life With the Weathermen.

UPDATE April 2013: With the Boston Marathon bombings fresh in our minds, every sane American would denounce and shun the low-life scum who engage in terrorism. No matter what their beef is (Ayers opposed our Vietnam involvement), there is simply no excuse for taking the law in your hands and blowing up innocent people and joking about it. Bernardine Dohrn, then a Weatherman pal and now the wife of Ayers, sung a parody of a Bob Dylan song (“Lay, Elrod, Lay”) to taunt Richard Elrod, a Chicago district attorney who was permanently paralyzed in a Weatherman riot.

Sick.

Dohrn is also notorious for rejoicing in the brutal slaughter of actress Sharon Tate and retail store owners Leno and Rosemary LaBianca by the Charles Manson clan, who also hatched a bizarre plan to take over the United States. Speaking about Tate, who was 8 months pregnant at the time of her murder, Dohrn said, “First they killed those pigs, then they ate dinner in the same room with them, then they even shoved a fork into the pig Tate's stomach! Wild!

Other sources state that Dohrn voiced something very similar: “Dig it! First they killed those pigs and then they put a fork in pig Tate's belly. Wild!” and, speaking of the LaBiancas who were stabbed several dozen times, she bubbled, “Offing those rich pigs with their own forks and knives, and then eating a meal in the same room, far out! The Weathermen dig Charles Manson!”

Obama chose not only to socialize with those bombers, but to launch his political career in their home. Of all the alternative people and places, he cozied up with them?

For all his training in law, Obama forgot one of the most important lessons: prisons are not the only way to punish people who hurt others; shunning can be even more effective. If Ayers and Dohrn were shunned by everyone forever, they would have been very miserable. People now thinking of bombing or some other domestic terrorism would be deterred knowing they would pay a life sentence for their act. Instead, would-be bombers see Ayers and Dohrn living the good life and rubbing shoulders with Obama—that's more of an incentive than a deterrent.

Easy for me to say? No. I've shunned people who broke the law, though in less extreme ways. Years ago I met a beautiful, sexy, friendly, and down-to-earth woman who instantly liked me. I'm not one for much PDA beyond holding hands, but I was so magnetically drawn to this stunning woman that we were kissing (and kissing and kissing!) while waiting for a table in a restaurant. Later, while driving, out of the blue she told me she never bothered to pay taxes, or even file. That caused my hormones to fall back to Earth, erasing the passionate ideas brewing in my mind.

I'm not fond of taxes (who is?), but I refuse to have anything to do with people who break such a fundamental law. She really wanted me (yes, I know, that's hard to believe), so by rejecting her for her transgression, she will pay a price for her wrongdoing even if the government never prosecutes her.

Now imagine everyone were that principled. We'd need considerably fewer prisons because only mentally ill people would risk the societal retaliation.

President Obama is unquestionably a genius but he blew a chance to do the right thing in the case of Ayers and Dohrn that could (certainly now with his Bully Pulpit) pave the way for a powerful alternative means of retribution.

Mark Moore of the Arkansas Watch blog presented a compelling case that Obama, who denounces bigotry, is actually bigoted against people who don't fit his mold of what people should be like. Moore astutely noted that “Most bigots are blinded to their own bigotry,” so it isn't surprising that Obama sees bigotry only in others—never in himself. If Obama had a Joe The Plumber-like encounter with someone as smart as Mr. Moore during the campaign, he wouldn't have been elected President. Obama's gift for public speaking camouflages the fact that he is an intellectual lightweight who flubbed college so badly that he was too embarrassed to release his college grades, and was accepted into Harvard Law School not because of his academic prowess, but because he had the right radical connections.

Read Moore's posting on this topic

UPDATE: I am now much less reflexively anti-Obama than I once was. He's passed some great legislation (example) and done a superb job for some of his supporters, but he seems to want to help only them at the expense of others. Feel free to correct me if you think I'm wrong about that.

Related articles:

Understanding the appeal of Obama

Obama isn't a socialist, but . . . .

Notes:

1 I worked in one ER in which we paid a certain fee for malpractice coverage on every patient seen. The malpractice insurance company gave no discount for uninsured patients, so the money for that came out of my pocket. Since few of them paid for their care, I lost a substantial amount of money by treating them. The new tractor that I want so badly is still sitting in the dealer's showroom because the money that could have paid for it instead was paid to give me the privilege of treating perhaps 1000 uninsured patients per year. Don't get me wrong—I don't begrudge giving free care to people who need it, but I cannot understand how the federal government is acting within its constitutional authority to compel ER doctors to work for free—isn't that essentially part-time slavery?—by creating an unfunded mandate forcing us to see every ER patient regardless of their ability to pay. If patients cannot pay, and the government forces us to treat them anyway, why can't they reimburse us for that care, or at least pay our expenses so we don't lose money on every case?

I was interviewed on the Ron Jolly Show (WTCM, AM-580, Traverse City, Michigan) before the 2008 Presidential election to discuss universal healthcare. During that hour-long interview, I proposed one way for the federal government to help cover uninsured patients: give doctors a tax credit for treating them. This would be great for patients, and good for physicians, surgeons, and dentists who chose to participate: they could essentially trade their time for a reduction in their tax liability. ER doctors must now see every patient, but this burden is not imposed upon other specialists even when the need is pressing. Unless he is on-call, a cardiologist has no obligation to provide care to uninsured patients with heart problems, but ER doctors must care for them in addition to patients with toothaches, rashes, and afflictions even more trivial.

In that interview, I also stressed one of the fundamental mistakes that people and politicians make about healthcare: they are focused on health insurance, not health. Doctors give lip service to preventive health, but they don't have the time or the knowledge to do even 1% of what they should to keep their patients healthy and vibrant. I graduated at the top of my class in medical school, so I obviously paid rapt attention to what my professors said—and what they did not say. They either knew next to nothing about health, or purposely glossed over that topic—perhaps because of how pharmaceutical industry dollars warp the practice of medicine. Note my degree: it's Doctor of Medicine, not Doctor of Health. The focus in medical schools is primarily on drugs. I spent many years before and after med school learning about health, which most doctors ignore as much as politicians ignore ethics.

The only way that we can provide affordable healthcare is by making people so healthy that it eliminates the need for most healthcare. In the 2008 Presidential campaign, both candidates advocated preventive medicine as a way to economize, yet their plans were laughably naive—even childishly simplistic—in presenting practical ways to achieve that goal.

As a doctor, I can assure you that politicians know almost nothing about healthcare. During the 2008 presidential campaign, Hillary Clinton shadowed a nurse for a few hours—that is, followed her around to observe what she did. After that, and even years before when her husband was President and she proposed HillaryCare, she felt sufficiently informed about healthcare to overhaul it. That would be laughable if it weren't so tragic. Most of what nurses and especially doctors do is in their heads, so it isn't externally visible.

For example, when I diagnose patients, all I appear to be doing is talking with patients and taking notes, but my mind is whirring away analyzing the incoming information and generating a list of differential diagnoses and thinking of what I must do to rule in or rule out the various possibilities. Hillary could look at me and walk away with little idea of what the diagnostic process is truly about, but that lack of knowledge doesn't stop her and others like her from tinkering with things they don't understand.

Update:

The money she offered me per pill ($5) seemed high at the time, but a TV program about Alaskan State Police said that oxycodone sells there for $400 per pill. Yikes! It's a shame anyone wants to abuse drugs in this way considering the fact that there are natural, safe, and even healthy ways to obtain a high that lasts much longer and has no potential for rebound dysphoria. People don't use drugs to ruin their bodies and lives; they obviously do it for the high. Considering the prevalence of drug use and the staggering cost and ineffectiveness of controlling it via law enforcement, wouldn't it make more sense to teach people natural ways to get high? Besides inducing what I term a million-dollar mood that can last all day, this would trigger a number of direct and indirect secondary benefits to the individual and society, such as by reducing the crime rate. I later found a better, more reliable mood booster and mentioned that in an unrelated article.

Notes:

  1. Why good people do bad things
    Excerpt: “When facing an ethical dilemma, being aware of the temptation before it happens and thinking about the long-term consequences of misbehaving could help more people do the right thing …”
    Comment: Could help ethical people do the right thing; unethical ones do whatever they think they can get away with.
The views expressed on this page may or may not reflect my current opinions, nor do they necessarily represent my past ones. After reading a slice of what I wrote in my various websites and books, you may conclude that I am a liberal Democrat or a conservative Republican. Wrong; there is a better alternative. Just as the primary benefit from debate classes results when students present and defend opinions contrary to their own, I use a similar strategy as a creative writing tool to expand my brainpower—and yours. Mystified? Stay tuned for an explanation. PS: The wheels in your head are already turning a bit faster, aren't they?

“The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”
F. Scott Fitzgerald

Reference: Imagining dialogue can boost critical thinking: Excerpt: “Examining an issue as a debate or dialogue between two sides helps people apply deeper, more sophisticated reasoning …”

Comments (3)

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Comment #57 by Meg
December 17 2010 11:43:54 AM

We need more docs in office!

Spot on. Interestingly enough, when I went though medical school at U of M, they had to start formal ethics classes. At first (having attended Hillsdale College myself), I thought the classes were a silly waste of time, until I watched my classmates flub a question asked by an elder attending during one of these ethics classes. "You're a resident rotating in a private office and the doctor asks you to upcharge and bill for services not rendered on his Medicare patients. He says he has to do this in order to continue caring for them. What do you do?" Every single one, said to do as he asked. I sat for a long time watching the attending's eye grow wider. I finally blurted out..."it's Medicare fraud! What's the matter with you guys!!" I'd say nearly half of medical training is learning medical culture, code and ethics, drilled into us by every mentor and attending. The science and drugs change, the ethics do not. Having those core values guide our decisions...that's what makes us doctors.

Comment #56 by Kevin Pezzi, MD • Website: www.ER-doctor.com
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December 17 2010 11:01:45 AM

Re: comment #55 by Anonymous: That's a great point about why the "I'm only human" excuse isn't sufficient to exonerate reprehensible behavior. If it were, I could have used that flimsy excuse to justify sleeping with the supermodel I mentioned in the article above.

Comment #55 by Anonymous
December 17 2010 10:48:49 AM

I agree with what Dr. Pezzi is saying. Politicians often like to exonerate themselves, saying that they are "only human" when they do something wrong. That would never fly in the medical world on any level. Why is it so excusable when you are supposed to be a public servant?

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