Ophthalmology Business

MAY 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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Physicians and staff need to understand what moral transgressions look like—and how easy it can be to overlook such misbehaviors W hen Lance Armstrong admitted his doping use to Oprah, my first reaction was, "How was he able to deny and lie about it for more than a decade?" Probably a huge factor motivating Mr. Armstrong's concealment of the truth was his fear of lawsuits because his doping use had breached multiple, highdollar contracts with sponsors that required him to avoid doping agents. Still, I wondered about how he was able to live with himself for so long. Moral psychologists talk about "cognitive dissonance" which, in Mr. Armstrong's case, hypothesizes that he had to figure out a way to "spin" his lies to himself such that overall, he could still perceive himself as a decent, even ethical, person. This is important: Most people, especially Westerners, have a deepseated psychological need to understand themselves as moral and upstanding persons despite the fact that no one is morally perfect. In his hierarchy of needs, Abraham Maslow emphasized the importance of selfesteem, which fits hand in glove with my perceiving myself as a respectable, moral human being. On the other hand, everyone commits moral transgressions from time to time like cheating on their taxes, lying to their spouses, or engaging in excessive risk taking that can harm others (like driving too fast, eating or drinking too much, working too hard, and refusing to care for themselves in healthy ways). Still, we all have to face each and every day— laden as we are with these all too human faults—and still feel good enough about ourselves to go about our business. Consequently, whether we're talking about fairly modest human failings or whoppers like Mr. Armstrong's, human beings learn to implement cognitive strategies that allow them to "make room" for their misdeeds so that they don't become psychologically overwhelmed by them. Perhaps the chief mechanism used for that purpose and which seems especially likely in Mr. Armstrong's case is that he had an enormous capacity to rationalize his misbehaviors (assuming that he was- " When ethical sensibilities break down, there can be unspeakable anguish and penalties. We should therefore be keenly aware as to how rationalization can blind us to our moral transgressions ... " n't suffering horribly from a crushing sense of guilt that he stoically tolerated on a daily basis). The cognitive dissonance model would say that Mr. Armstrong somehow managed to compartmentalize or minimize his lies in a way that allowed his maintaining a positive enough self-image that got him through the months and years. That is always the goal of moral rationalization: to make the stronger argument or course of conduct, which in Mr. Armstrong's case would have been to fess up, appear weak or stupid against arguments encouraging his ongoing deceit that, through rationalization, would appear strong and persuasive. Implications for ophthalmology So what in the world does this have to do with ophthalmology? I participated in a session at the 2013 ASCRS•ASOA Winter Updated meeting in Aventura, Fla., where ophthalmology administrators offered some cases for ethical discussion that were taken from their personal experiences. Consider these two: 1. The owner doctor starts a new type of cornea procedure that is refractive in nature but he adamantly insists on identifying a reimbursement code for billing and receiving payment from an insurance company. The administrator refuses to bill the insurer, but the ophthalmologist threatens to fire the administrator if he doesn't. 2. As a new administrative employee, you discover that your ophthalmologist's practice has not made any effort to refund patients' excess payments above allowables for several years. He only refunds patients who complain, continued on page 16 May 2013 • Ophthalmology Business eZine 15

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