Let’s Rewrite the Rules

January 11, 2013

Most physicians have no input into the writing and rewriting of their rules. When the rule-changes don’t consult us, how locked into this game are we?

Cast your mind back to childhood days on the playground. You’re playing some kind of game with your friends, and generally having a good time. During a lull in the action, one of your peers calls for a “new rule” to the game.

Rapid-fire, several thoughts go through the minds of all involved. Was a new rule necessary? Will it improve the game? Why is he proposing it? Does he think it’ll give him an advantage, or disadvantage someone else?

Whether or not the rule gets implemented will depend on a few factors, but ultimately the most important will be whether a critical mass of the players is in support of it.

As one grows older (and hopefully wiser), one encounters would-be rule-changers in other walks of life. The rules get more complex, or at least their repercussions do. Certainly, the stakes get bigger than who’s going to win the next round of freeze tag. As an adult, the ability to protest unwelcome outcomes from imperfect rules ceases being as simple as yelling that one wants a “do-over.” It might take a couple of painful, learning-the-hard-way experiences, but one learns to pay attention when the rules of engagement are potentially being changed.

It is, of course, entirely possible that a would-be rule-changer is being selfless and acting out of a true sense of fairness, standing to gain nothing from his proposed new way of doing things. (Not even calculating that he’ll gain popularity amongst others who stand to benefit from his new rules, a la politicos and union leaders.)

Such a paragon of social justice may find it frustrating when those opposing his initiatives allege that he really does have an axe to grind, even if they have to resort to improbable conspiracy theories and character assassination to do it. He may seek ways to prove to them (and, more importantly, to onlookers undecided on the issue) that his motives are pure.

He would dispel much of their suspicion by including them in the process of creating and promoting his new rules, explaining plainly to them how he came to the conclusion that change was necessary and how he thinks his proposals would accomplish this. Listening to their input and accordingly adjusting his envisioned changes would be key, rather than giving them a token audience or fobbing them off on an underling.

A very potent source of distrust against a would-be rule-changer is the perception that he, himself, will not be subject to the new rules he is writing, that he has no skin in the game. For instance, a hospital administrator issuing edicts regarding the medical staff’s clinical activities. Or a Senator’s proposed adjustment to earned income taxes when he, himself, derives his millions from capital gains.

For some, such challenges may seem insurmountable (especially if their motivations in rewriting the rules are not, in fact, quite so pure). Indeed, modern leaders - elected and otherwise - seem increasingly willing to forego popular support for their actions, and are satisfied with whatever bare minimum it takes to further their agenda.

Health care has seen quite a trend in this direction - in fact, it seems that the vast majority of physicians have no input into the writing of their own rules, which are accumulating with ever-increasing speed. When the rule-writers no longer even bother with the pretense of consulting us, just how locked into playing this game have we become?