In Politics and Medicine, the Reasonable Guy Loses

October 26, 2012

In the presidential debates, being reasonable isn’t rewarded. The same is true in medicine, where our reasonableness is met with more cuts and regulations.

The presidential debates are finally over. I watched them all -whether that makes me an engaged citizen or a glutton for punishment. The debates, the media coverage, and the reactions via social media underscored a thought I’ve had for years: Being reasonable doesn’t seem worth it anymore.

If you ask, people will emphatically tell you that being reasoned, thoughtful, and flexible to new ideas is a good thing, and of course they want to see such qualities in those holding positions of importance. But in practice, those same people will express the belief that their favorite candidate “schooled” the opposition by interrupting him more frequently, and inserting obliquely-insulting zingers whenever possible. Being reasonable and remaining respectfully quiet while you listen to your opponent speak during his allotted time wins no points in this game.

Reasonability has also fallen by the wayside in the rest of our governmental process. The great compromises undertaken by opposing factions in the leadership of our country during the past 2+ centuries, finding common ground to get things done, don’t seem to be happening anymore.

Being reasonable has become a weakness. If two parties are on opposing sides of an issue, and one will budge while the other is unyielding, either the reasonable guy gives up the lion’s share of the middle ground or nothing happens. All the unreasonable guy needs is the ability to abide by the consequences of an impasse. That, and a willingness to appear unreasonable.

Because, at least outside of a political debate, being reasonable still wins a few points for likability. The reasonable guy stands out as a nice fellow, as a thoughtful person who can see things from other perspectives. He’s somebody you’re not afraid to approach with a differing viewpoint. Even the unreasonable guy likes him - after all, the unreasonable guy knows an easy mark when he sees one. The unreasonable guy might even feel a little bad about getting the best of him, time and again.

We in medicine - not just radiology - have been very reasonable. We’ve accepted round after round of slicing away at our livelihood - compensation, responsibilities, autonomy. We’ve even been proactively reasonable, self-imposing MOC programs, requirements for peer review, and rules of engagement which do not apply to those outside of our field. Part of the thinking has been that, if we show to the world how reasonable we’re willing to be at our own expense, the world will, in turn, respect us and be reasonable right back.

Fresh rounds of reimbursement cuts and new waves of regulation don’t seem to be bearing that out, however. Maybe it’s time for us to be a little less reasonable.