The rise and rise of unethical behaviour

This is actually a post about real life, which has some cross over into Azeroth.  What I actually wanted to talk about was...professional ethics.

I am one of those fortunate people that really loves what I do.  I love going to work, I love the work that I do, and if I find I'm not enjoying it, I don't do it.  People wonder, how can you love putting people to sleep all day long?  Is that even a job?  People can go to sleep by themselves! Surely anyone can do anaesthesia!?

Anaesthesia is a science, which dabbles in a bit of art.  If you think anyone can put someone to sleep, think again.  Look at what happened to Michael Jackson.  Even though his physician was a medical practitioner, he obviously didn't have the skills to look after an anaesthetised person.  Being an anaesthetist is a bit like being a pilot - it's the take off and landing which can be sketchy but usually the bits in between are smooth sailing.  That's why I have so much time to blog.

I think one of the great things about enjoying what you do, is that money is no object.  If it's interesting enough, you even do it for free.  I am no saint that works for free, but I definitely would not complain about  my income.  It's more than enough to keep in a lifestyle that suits my needs.  And I do charge my patients, so it's not like I'm working for peanuts.  But what is reasonable and what is unreasonable to charge, is what I have a bee in my bonnet about.

I have noticed increasingly that money makes the world go around.  In medicine, money is the root of all evil.  I have seen colleagues fighting over cases which give more money, seeing people chatting up and brown-nosing the surgeons so they can do their private work.  I see people whinging about others who get more private work, when really, it's none of anyone's business who is working with whom.  I see people having operations done by surgeons because they are privately insured or workers compensation (which means it pays a lot of money).  It makes me sad, because I feel that medical ethics has gone down the drain.  Operating on someone because you would get paid more for it? If the patient was public you would treat them conservatively, and not operate on them.  To me, that is unethical.

The other unethical behaviour I came across was lying.  In medicine, like anything else, mistakes are made.  You should own up to your mistakes.  I certainly own up to mine.  I've had complications from procedures, but these complications are an accepted part of that procedure.  I learn from those mistakes, I'm mortified by them, but I don't cover them up.  Being honest in our profession, I believe is very important.  It's when patients are LIED to, that's when they get angry.  And when I get lied to, I get angry.  If my junior training doctor lies to me about something (like they say they ordered a test but they didn't, or they did something dangerous then denied it) then they get a long tongue lashing from me about what is ethical behaviour.

The other day, one of the medical students was angry at one of my colleagues, another consultant, because he wouldn't let them attempt to do an injection of anaesthetic into the spinal cord.  Now this procedure has complications, and we usually only let our own training specialist registrars do these procedures, because they understand and respect the risks, and are willing to take on the responsibility of the complications.  It felt to me like even the medical students look at patients like pieces of meat to be played with, rather than people, and don't mind that their actions can have complications and consequences because it's all for their learning.  It made me upset, and I thought about how I need to educate these future doctors about ethics, empathy and treating people how you would like to be treated yourself.  That student was probably not the norm, as I often meet great medical students who would be great doctors, but I worry that this sort of attitude would be on the rise.  Students should be respectful to their elders, and not show their tempers like that anyway!  Hmph!

In medicine, medical fees are usually derived on what the medical practitioner thinks they are worth.  Each of us sets our fee structure to what we think we deserve to be paid.  The Australian Competition and Consumer Commission does not allow us to have similar pricing to our colleagues - they say this is collusion.  In medicine, you get a referral from your local doctor to see your specialist and then you have your operation with them, and don't really go shopping around for the best price.  It's interesting to me, because in real life we go hunting around for the best price of things like cars, computers, even toothpaste, but you have to accept this decision that people make about your health. 

And the funniest thing I find - is that if the doctor is very expensive, then people assume they are very good.  This attitude confuses me most of all.  There are a few of my colleagues who are very good, and I think are worth the money you pay for.  The rest of them, are no better, or even worse, and less experienced, than myself.  And people like that give my profession a bad name.

My father had a procedure done some years ago that required an anaesthetic - that procedure is something I do very commonly in my professional practice.  When he told me how much it cost him, I was astonished.  Firstly, the surgeons I work with, for those procedures, if the patient is in a health fund, then there is no out of pocket fee, or "no gap".  My fee, is also no gap.  It's a simple procedure, and it pays quite well already for 20 minutes of work.  However, my father's fee was three times the price I am used to seeing, and the anaesthetist bill was also 3 times my own fee.  And my parents' reaction to that?  "Oh, he must be very good, he's a professor!"  Are you kidding??  You were ripped off!  I was so horrified by their bill that I insisted they come to my hospital to have their procedure done the next time, done by one of my friends and colleagues - and it cost them nothing out of pocket.  And they even had a better outcome than the expensive one.  Go figure.

And they are not the only ones like that.  People in Australia really do think that the more expensive you are, the better you are.  Which I find... bizarre.

But I am hoping this is not the norm.  I think that there are just as many good and reasonable people out there as there are unscrupulous ones, and I hope that all you good people out there who need operations and things get the good, honest ones, not the money gouging ones who charge you just because they can.

I have never been good at making money from my private work - my fees are lower than most of my colleagues, but I feel happy with what I am making.  I think other people look at everyone else and think "Hey, they're charging x$ more than me, I think I can go at least that much as well!" which is normal, right?  But I feel embarrassed charging big $$ - it makes me wonder, is it a self esteem thing?  Do I not think I am worth much?

But I honestly don't believe I undervalue myself.  I don't think I have a low self esteem - in fact, I know I don't.  I take pride in the fact that I enjoy my work, and that others recognise that I enjoy it and am good at it. So why am I talking about this at all?  Am I envious of my colleagues that make more money than I do?

I thought about that a bit.  I am not envious.  Because I could easily charge that much money as well and keep quiet about it and earn big $$.  The reason I am talking about this is because this my World of Warcraft blog, and it is highly unlikely any other medical professionals I work with read it.  Talking about money and prices is very hush hush and closed shop in medicine.  I have often wished the public knew how much prices varied for operations, depending on which part of the city you live, and whether that would shock people.

I'll use this as an example.  In the more affluent suburbs, an epidural, for labour pain can cost someone up to $2000.  That's with top cover health insurance and you might be out of pocket about $500-$600.  In the less affluent suburbs, the normal price is $500-$800.  And people might think that the doctors out in the affluent suburbs are better... but I know for a fact that they are no better than many of us who work in the less affluent suburbs.

Another example, which I found a bit abhorrent - a well known, famous surgeon saw a patient for a tumour.  His fee was $40k - which is a lot.  Other surgeons I know, good and reliable ones, would do it for one third of that price.  When the patient said they would think about it, and ask around the surgeon said "By all means, look around.  But if you get it done by someone else and get a complication, that leaves you incapacitated, remember, you could have had it done by me."

Now what is someone supposed to say to that?  Talk about twisting your arm.  And complications can still occur, no matter how great a surgeon you are!  I don't deny that person was a great surgeon - but I DO object to suggestions like that, the subtle hints to put fear into someone.  I was so outraged, but I can't say anything about it.  People can charge whatever they want.  It's fair trade.

So, how does this relate to World of Warcraft?

Something like this happened.  Ouchies.

One of my Frostwolves guildies fell and injured himself, and he was sent to one of the posh private hospitals with posh prices and I was worried that he would have to pay a ridiculous fee when he could have had the same operation done for a lot less in a different part of the city.  I think that prompted the money concern with price gouging in different parts of the city.  Fortunately his fee was reasonable - it was within the range of what I said was reasonable rather than $600 more.

The other way it relates... well, as I said, I am pretty hopeless at making money.  The only way I know how to make money for SURE, is to work for it.  In real life, that means putting in more hours, picking up on call - working for the lowest amount of pay per hour (though by no means feel sorry for me, because the pay per hour is very high).  And that, is just like doing dailies.  I make most of my money from doing dailies.

Maybe I should read Spazzer's Gold Guide!

I get embarrassed charging high prices for anything.  That includes things I sell at AH, and prices for enchants or crafted items.  And in real life, I'm like that too!  I look at the prices my colleagues charge and if it was me, I'd feel embarrassed!  I shouldn't be though, because if people are happy to pay for it then I should be glad (and I should charge that!), but I can't bring myself to do that, I feel... guilty?  I'm not even sure if that is the right word.

But I really object to price gouging.  I object to people taking advantage of others because they don't know any better.  I know the attitude of most people is "If I can get away with it and some idiot wants to pay that, then why not?" I don't like people putting things on the AH for a really ridiculous price in the hope that someone will accidentally click "buy now" and pay 100x more than what it was supposed to be as an accident.  I suppose it really isn't unethical, but it is taking advantage of other people's stupidity.  But should we be taking advantage of that?  Shouldn't we be helping and educating those people?

And don't get me wrong, if you can make money that way, then good for you!  I can't, because I really truly am hopeless at it.  I'd give everything away for cost if it was up to me :P  I'm just trying to explain my difficulties with making gold except for the only way I know how - to grind it.  So for those of you who wonder why I can't make money from the AH - now you know why.  Because I'm dumb at it!

Back to my original topic - how can I address this rise in unethical behaviour?  All I can do really, is educate, and lead by example.  Calling people out publicly doesn't work and it's just nasty and rude.  I don't think I can change a whole generation of junior doctors, but hopefully others will see the positive side of doing what I do, and follow suit.  Some people don't want to be helped.  Others are already good.  It's the ones in the middle of the road, on the path between good and bad, that I hope to be able to steer in the right direction.

Phew.  Thanks for reading the rant.  I think I've finished now.