Hot & Cold Ethics
Experience is the Best Teacher—For Those Willing to Learn
Students who enroll in PBI’s Medical Ethics and Professionalism course are often surprised by the experience. Having studied ethics in medical school, they arrive expecting more of the same: lectures about moral reasoning, essays about compassion and professional detachment, perhaps small-group discussions of hypothetical scenarios. What they encounter is far more intense and personal.
Almost without exception, those attending the class have been disciplined for an ethics violation or expect to be. Rather than discussing scenarios, they find themselves talking to each other about their own experiences. Some are in denial, unwilling or unable to accept their culpability. Others are angry at the board or their patients—anyone other than themselves—who they can blame for their predicament. Almost all are in shock and emotionally on edge.
As the course progresses, participants talk about what they’ve been through. Gradually, with the encouragement and support of the instructor and others in the class, they begin to think seriously about why they acted as they did. It can be a life-altering journey. People who have always prided themselves on their professionalism come face to face with problems and mistakes that threaten their professional identity and sense of self-worth.
The goal of all this introspection is to create an individualized Personal Protection Plan that will help them avoid future violations. At the heart of the plan is PBI’s first rule of Professional Boundaries:
Everyone has a violation potential, which is constantly changing.
This comes as a shock to most people, who thought their spotless record ensured a bright future. Most arrive at PBI utterly bewildered. “I’m a good person” they say. “How can this be happening to me?”
The reality is that age and experience are risk factors. While people at all stages of their career commit violations, those in their prime and nearing retirement often face the most intense challenges—including the identity crises common to both stages—with the greatest sense of entitlement. “It takes time, wisdom and experience to get into trouble,” Schenthal often tells his classes.
The PBI Violation Potential Formula helps people think through the forces that resulted in their violation, both the external risk factors and the internal vulnerabilities. Each of these magnifies the other, which is why the two variables are multiplied in the formula. For someone going through a divorce, feeling isolated and neglected is a vulnerability and an adoring patient is a huge risk factor. For someone facing college tuitions and growing debt, a colleague’s questionable business offer is far greater risk.
Whatever risks and vulnerabilities a physician faces, the likelihood of committing a violation is raised exponentially by Resistance, an unwillingness to confront the problem. You can’t resolve a dilemma you refuse to admit. And if you refuse to even consider the fact that you are in denial, your violation potential skyrockets.
Accountability helps mitigate all these forces. Whether it’s a medical chaperone or an attentive accountant, a watchful presence is a powerful deterrent. And the most powerful form of accountability is often board discipline. If the discipline is serious enough, the person on the receiving end is made painfully aware that the board is watching and stands ready to revoke their license if they commit another violation.
The protection plan each person completes at the end of a PBI ethics class reflects what they have learned about their vulnerabilities, risk factors, resistance and accountability. It helps them recognize situations in the future that for them involve serious risks and it gives them tools to avoid or mitigate those risks. The lonely physician with a flirtatious patient makes arrangements to always have a chaperone in the room during examinations.
Of course, the protection plan is only useful if it is used, and kept up to date. Situations change. The physician going through a divorce may eventually remarry, but may also lose a beloved parent. And as situations change, so do vulnerabilities and risk factors, which is why many PBI graduates choose to participate in Maintenance and Accountability Seminars. These weekly conference calls with fellow graduates give participants a chance to discuss challenges they are going through and revise protection plans as needed for ongoing accountability.
Those who have lived through board discipline and benefitted from a remedial class are changed by the experience. The class they attend is nothing like the ethics class they expected and the knowledge they gain, often at great personal pain, is something they are unlikely ever to forget.