When I was in medical school it was common practice for drug companies to buy everyone in our class a doctor’s bag, stethoscope, and even an otoscope. (For reference, these are “gifts” that would currently cost well over $100 each). We didn’t think anything of it at the time – It had been this way for decades and was considered completely normal. Pharmaceutical company “gifts” were also part of my residency, mostly food brought to our clinic or lounge and “free meals” at fancy restaurants in exchange for a presentation about their newest (and most expensive) drug or device. (Not to mention the thousands of pads of paper and pens that were left in every clinic.)
“What has become unusual, at least for me, is how hard it now is to separate the plate in front of me from the patient in front of me, the one who asks whether there is a cheaper alternative, whether the coupon will still work next month, or whether they can wait until payday to fill the prescription.”
Timothy Lesaca.
Timothy Lesaca is a private practice psychiatrist who no longer accepts pharmaceutical-sponsored lunches in his office and wrote this essay to explain why. Reading his story made me think about my own decision to not accept gifts from drug reps and, in particular, the event that started me down that road…
I was getting ready to leave the hospital when a friend (and fellow chief resident) called…
“Where are you?”
“I’m still at the hospital.”
“You should come over to the [name of hotel across the street from the hospital]”
“What’s going on?”
“There’s a great dinner being put on by [name of a company that sells antibiotics]. You can stay for the food if you have time, but the important thing is that all you have to do is sign in and they give you a hundred dollar bill!”
“Thanks!”
And then it hit me…
The next day, I called my dad (who taught business ethics at the University of Texas) to tell him the story and discuss how uneasy the whole thing had made me feel. He listened carefully, paused and then said, “You know, that reminds me of a story.”
Winston Churchill was invited to a formal dinner and, being the guest of honor, was seated next to a “very important” woman who happened to be an insufferable jerk. He put up with her for most of the dinner but finally couldn’t take it anymore. He turned to her and asked “Madame, would you sleep with me for a million dollars?” She was flustered but with his reassurance that it was just a thought experiment she finally responded “Well, yes, I suppose I would.” He then asked “Would you sleep with me for twenty dollars?” This time she was really insulted and in a huff asked “What do you think I am? A prostitute?” To which he responded “We’ve already established that… Now we are bickering over the price.“
Medicine is filled with moral injury, that horrible feeling when you know the right thing to do but work in a system that doesn’t let you do it. That’s why, when faced with a clear moral dilemma that you can control (no matter how small), it’s important to summon your moral courage to do the right thing. Those little choices are how we calibrate our moral compasses, how we remember what we believe – and who we are trying to become.
Every single choice we make, no matter how small, is the ground where who we are meets what is in the world.
Wayne Muller
