TO my children:
- why I am no longer employed.
- it is important to me that you understand fully.
The insanity you see/hear/read in the “news” may seem remote to you; like it doesn’t affect you. The forces it represents, however, have already captured the permanent organs of government, federal, state and some local - the bureaucracies and NGO’s (like the Joint Commission that accredits = controls healthcare institutions)) as well as most employers. In this new paradigm, children age 5 - 8 are being taught there is no such thing as biological sex, that there is some variable number of “genders”. Employers are not much better. Even if they are not willing participants, they are regulated by these entities with power over them and that translates into practices in the workplace which can literally impoverish you and end whatever career dreams you may have because of a trivial word or act. What just happened to me is an example of how progressive/‘woke’ political programs have already reached down into the HR departments of workplaces, to the detriment of the institutions, their employees and their missions.
To be precise, the party in power in all these institutions - the Marxist/Democrat party’s - mission is “equity”, its twisted view of “fairness”, based largely on identity politics and class warfare as a means of holding raw power. It is NOT about equality before the law; that’s why they don’t use the word equality. In my case, “equity” demands that a physician’s behavior be judged by the exact same way as a janitor’s when it comes to discipline for alleged workplace infractions. Any hierarchy based upon credence or merit when it comes to employees is impermissible. By this corrosive standard, a physician’s crede ntials and meritorious, spotless record of service cannot be permitted to afford him/her any more credibility when it comes to allegations of marginal wrongdoing than any other employee with lesser education or responsibility - even one with no crede ntials at all. Thus sayeth “equity”: same treatment, no discretion for decision makers based upon any personal attributes except that class or identity attributes are not only permitted, but must be taken into account in mitigation of any possible culpability of the accused! The end result is that from now on, the patients will not have care from me, whom everyone involved said was the best and most conscientious physician caregiver working for the institution. Had I been anything other than a white male of European heritage, I doubt this would have played out as it did.
Had this happened early or mid-career, it would have been devastating to me and my family, both career-wise and financially. The only reason I am not devastated is that I know I did nothing morally wrong and I have a lifetime of savings, aka ‘F#@k You money’. I should also say in this regard, I was very likely to quit in a month or so, because of the impending start of Computer Order Entry (COE), which requires completion of 11 data fields to write a single prescription. It would have been overwhelmingly burdensome and left virtually no time to actually talk with patients. Anyway, when others witness such events as happened to me they surely take note and become highly risk-averse. It leads to a “safe”, mediocre, colorless, non-vibrant, non-creative, unfriendly workplace. “Interests” take precedence over human warmth and connection - particularly in the caring professions. In the former USSR, whose practices are ascendant here today, they had a pertinent slogan: “I pretend to work and they pretend to pay me”. That, I fear, is where we are headed.
I retired from part time anesthesiology practice in September 2020 at age 76, after having practiced since 1978. How did my life go by so fast? It feels like only last week that I was a shy, insecure, scared kid with academic promise, a serious student. In preparation for retiring from anesthesia, because I had nearly 30 years of addiction recovery myself, in February 2019 I took a Saturday-only job as physician on a detox unit at a local drug/alcohol rehab center. My motivation was a slogan found in the book Alcoholics Anonymous - “For me to keep what I have, I have to keep giving it away”. In other words, though the work was long (with shifts lasting 6 - 10 hours with no breaks) and difficult, it was personally very rewarding. It is the nature of the work to not know whether or not one has made a difference in a patient’s life. One can only try and hope. The patients often told me they felt a bond with me because I revealed my own status as a recovering addict. That organic connection and common suffering among alcoholics/addicts constitute the soil in which the 12-step recovery programs like AA and NA took root almost a century ago.
Anyway, I was enjoying my work until last week, when the institution asked for my resignation. This was because I transgressed a boundary by - without really thinking about it, as I thought it a minor infraction for a good purpose - giving a ride home to a patient who was leaving. The administration said they really didn’t want to do this (one even wrote to me saying “it stinks”), but felt they had to because “everybody knew about it” (I made no secret about what I was doing, since, given my physician status and therapeutic motivations, I did not consider it wrong) and because (unbeknownst to me) they had, not long ago, fired (or demanded resignations - I don’t know which) others (not physicians) who had done the same thing. The administrators said “we have to be consistent”. I am unaware of the identity particulars as to the person or persons (I mention this because it often plays a central but unspoken role in things nowadays). I should add that by accepting my offer to resign (which I did as soon as my medical director called to inquire about what happened) and not terminating me, I was at least spared possible loss of my medical license.
I made no effort to dissuade them from their decision (had they terminated me instead, I would have fought like hell to preserve my license). I wrote a gracious letter of resignation, indicating that I had done my best (everybody knew that and frequently told me I was the best physician they had - the nurses actually refused to discuss the incident with the administration to try to protect me, I later learned). I also wrote a letter to the staff telling them what they already knew - that I agreed to drive the patient as an act of kindness and an effort to offer him a modicum of dignity (he was an offender, having recently been released from prison where, now age 42, he had spent half his adult life and felt no one would give him any chance at all).
This unusual circumstance came about as I was finishing up a relatively short work day of 7 hours at around 3pm. As I was making my last computer entries in the exam room, a male patient stuck his head in the door, said he was leaving and asked if the institution could give him a ride home. I said no, we didn’t do that. I had had a routine visit with him about an hour earlier and, knowing some of his history (including the fact he had started on Suboxone maintenance and had an appointment at a clinic 1 week hence), felt some sympathy for him. Without thought, I said I was leaving in 5 minutes and asked where he lived. It was but a slight deviation from my usual route, so I offered to drive him. It never occurred to me this act came with the professional death penalty attached.
While I was aware this was a technical boundary violation (aimed to maintaining a “professional distance”, which is, itself, somewhat un-helpful when trying to help addicts, who desperately need real connection with others). Their caregivers in rehab, including physicians, are the first to model and introduce this human connection which patients need to find elsewhere (in AA and NA) after they leave treatment. If we don’t effectively show them that such real human warmth and connection are possible and that it relieves their cravings for substances, they are unlikely to pursue such connections after leaving us. Institutions, on the other hand, as compared to caregivers they employ, are less interested in that, though. Rather, they focus on eliminating any possibility of risk of having to deal with allegations of wrongdoing by one of their employees. So, to be “safe” we must not engage in ordinary human kindness like driving a patient home. Since I was absolutely certain nothing inappropriate would happen, I was sure the benefit to the patient outweighed the theoretical risk of crossing this particular boundary in this particular way. Even though I am old enough to be harmless, had it been a female, I would not have done it, given the risk of accusation of a sexual boundary violation. I suppose this very kind of thinking makes me guilty of some -phobia or other. Anyway, I thought that, as a physician it was within my purview and permissible judgment to bend this rule to benefit a patient to whom the gesture would be helpful and possibly effective in improving his chances of recovery. It boils down to institutional rules aimed at being legally bulletproof versus a physician’s discretion bend a rule to do a kindness in an attempt to be therapeutic in an effective way.
Such events were not unusual for me. When I was in residential treatment, you see, for almost 5 months, 30 years ago, I was frequently driven (only myself and the rehab employee or therapist) by the staff at the rehab to various places. As well, I had dinner at the homes of several of them while in treatment. These people were most all in recovery and were part of the community of recovering people - and as we say, they “Walked the walk”, not just “talk the talk”. In addition, over the past 10 years, I had intermittently worked at “The World’s Most Expensive Rehab” - The Kusnacht Practice in Switzerland, where, as a therapist, I actually lived with the patients in the same apartment and took them everywhere they had to go. So, in my cultural experience of rehabilitation, there was nothing unusual about being alone with patients outside the facility itself. Finally, over many years I have driven other members of the recovering community many places, including to and from meetings - even to out-of-town rehabs.; it is simply what we do for each other. It is normal by recovery community standards. Again, if the patients are not shown such kindnesses in rehab, they may well never show up at any 12-step meetings after they leave.
So, why was I, in effect, fired for doing a good and decent deed with the best of motivations. I’m sorry to say, because this is the former United States of America, whose culture - including governance via technocratic diktat - has become unhinged and largely insane. It is obvious that those in appointed positions in government are virtually NEVER accountable for any of their decisions; those decisions filter down to the daily lives of ordinary citizens - often to their detriment. I see myself as a victim of this sorry state of affairs (this “victim” sees no corresponding entitlements to soothe his hurt feelings). In effect, those with no accountability promulgate thousands of minuscule rules for the rest of us and those rules are applied by the technocracy under the banner of “equity”, with vigorous cheerleading by the de facto state organs - big tech and the mainstream media.
How does “equity” play out in bureaucratic institutions like my rehab? Well, unlike “equality” before the law, which is understood by all and creates a level playing field with discretion lodged in decision makers, “equity” is a political word for someone’s peculiar idea of “fairness”. In this case, since someone else had been previously let go for the same act, I must be given the same penalty. But, does this decision withstand rational analysis? I say “No”, for several reasons.
First, the other individual who drove a patient somewhere (and I don’t know if there were other motives or if anything untoward happened) was not a physician. My medical license empowers me to undertake behaviors which other cannot legally undertake. I have a license because I have crede ntials (from the Latin for belief or trust) embellished by a reputation for trustworthiness in my present institution (there was never a single complaint against me, in a setting where complaints about staff are frequent), backed up by a 40 year track record as a physician who made literally life and death decisions, daily.
Somehow, then, the institution dared not distinguish my status as a physician from that of, say, a janitor. Don’t get me wrong. I do not look down on janitors and would not like to work in places without them. They are (should be) equal in the eyes of the law and surely in the eyes of God. However, they are not empowered to practice medicine. They lack the education, crede ntials, trust, which has been earned by physicians. It is reasonable and sensible that, through such merit, physicians are empowered to act in ways denied to the general public. When you stop to think about it, some such hierarchy is essential to the functioning of any institution or government. Without it, chaos would ensue. The now-forbidden word here is “merit”. It is loudly said to be “racist”, without any evidence. Any benefit of the doubt extended my way would automatically be loudly deemed to be “ white privilege”; personal merit is verboten .
Now, while hierarchy is essential and extant most everywhere, political correctness requires that it be denied whenever made explicit, especially to the extent that it can be (however implausibly) construed to benefit: whites, men, heterosexuals, known non-progressives. Example: numerous individuals were fired for posting on social media (not even at work) “All lives matter”. Heretofore, such a statement was anodyne, self-evident, a truism. In case you don’t believe we are in the throes of a Maoist cultural revolution, just ask yourself if such a thing would have even been imaginable a mere 5 years ago.
This unwillingness of the administrators to distinguish a physician’s (regardless of his ethnicity) acceptable prerogatives from those of any employee with less credibility ( crede ntials) and responsibility is no accident. It represents a small example of the intentional abandonment of the Common Law school of jurisprudence, which had been in effect in England since the beginning of the Second Millennium. This is a self-correcting system of establishing and publishing precedent, so that ordinary people may reasonably predict what the law says, for a given a set of facts. It is a clear, orderly, predictable manner of establishing and refining law. It conforms to common sense is also eminently practical and accessible in its workings to the general public. It is law established and applied on a case-by-case basis. One might say, then, it is a system informed by the value of the individual, rather than the class (or any other characterization or classification of the individual); because of this very attribute, that it is “a system of Laws, not of Men”.
A Common Law system of legal decision making requires careful thought and good faith (“civic virtue) of the practitioners - judges and lawyers. In this system, judges exercise some discretion, flexibility. The system requires a statement of what the law is which is being applied to this specific set of facts; the reasoning by which the decision is made, drawing on precedent of previous cases; announcing why this set of facts is sufficiently similar so the precedent applies OR saying that these facts or persons are in some way sufficiently dissimilar that the precedent does not apply. An essential part of this process is explaining why the present fact pattern to which a given law might be applied is the same as or different from previous cases which seem facially similar. If the decision maker finds, for example, that a given defendant in a case (either criminal or civil) is not similarly-situated to the defendant in the previous case being put forth as precedent, the judge must say what distinguishes this defendant (or plaintiff, or fact pattern) from the precedent.
Alternatively, if the individual or fact pattern is sufficiently similar to that of the precedent and decides to apply that rule, the judge must explain why that is so. In passing, it is worth noting that making such comparisons requires thoughtful discrimination by judges among people, things and/or facts. This is another one of those words - there are numerous other examples of newly-politically-charged words, - on which politics has installed barbs, hooks and even prohibitions. I have a friend, an otherwise intelligent and thoughtful one, who has said at times, “That’s discrimination”! She’s a product of the public school and university system, and has somehow conflated racial discrimination (an unlawful and immoral category of distinguishing among human beings) with any mental effort to discern rational differences between any persons or things! The word, itself, and the mental exercise of comparing the attributes or value of most anything, is contraband in her mind, despite the fact she does it implicitly every day as an ordinary and essential part of normal living. This is a homely example of just why it is that progressives seize control first, of words. Having done this, the law and institutions bound language, body & soul, obediently follow.
In the US, the Common Law system of jurisprudence has been largely replaced by an alternative system, called The Rationalist School of Law. In progressive circles, this is called progress. This jurisprudence is more closely allied with the Napoleonic Code, which consists of a compendium of fact patterns and law to be applied. Under this system, the law is said to be “self-executing”. The state’s minions create an encyclopedic compendium which purports to account a priori for every imaginable fact pattern of human behavior, along with the rule to be applied. The job of the judge in this system, then, is to merely leaf through the rule book and point to the rule which applies. The law is self-executing in the sense that judges have no discretion; they simply point to the rule and it applies. No possibility of human error; no room for human judgment; no human mercy; wrung dry of all the human juices. Impeccable, inflexible. A system only statists could love. Undoubtedly, the same AI which will soon inform the Dep’t. of Homeland Security as to “misinformation” will replace human judges entirely. If you think the legal system today is a failure and unaccountable, just wait until you hear : “not me -the computer did it”. Deeply and opaquely buried in the secret algorithms will be categorization of plaintiffs and defendants alike, according to things like race or other “victim/oppressor” status - just like is actually happening today, less rigorously sub rosa . As is exquisitely clear from the news, equality before the law is another casualty of “equity”, and it will only get worse in the future.
As to the case in point, as to my having given the patient a ride home, as an alternative to reflexly asking me to resign, the administrators might have said, “He is a licensed physician with up to date crede ntials. His record as a physician is without blemish. We know his work and temperament over 3 full years. He has demonstrated his skills in helping patients. Unlike everyone else, there are zero complaints about him from patients. Everyone, patients and staff, like and respect him. We must bear in mind that we employ people and permit volunteers with no credentials, other than a driver’s license and a criminal background check, to drive patients to various places (like dentist appointments) most every day . Thus, though we fired an employee for doing the same act spontaneously, the act of driving a patient, itself, is merely ordinary, malum prohibitum , not malum in se . What was deemed un-permissible was the spontaneous nature of an ordinary act by a physician. Yes, this is a technical “boundary” transgression. In this case, though, we distinguish a physician from other employees based on credentials and other qualities of demonstrated merit. It is sufficient to remind him with a mild reprimand, that we believe there is sufficient risk of harm in driving patients anywhere spontaneously, that is should be discouraged”. Case closed. That is not what happened, in part because merit and trust have been deemed in our society to be without value in judging individual behavior in the workplace. One rule for all, with special consideration permissible only when it comes to ethnicity and class. This is what “equity” means.
Ironic, isn’t it, that elites in government bureaucracies are virtually never held accountable for their performance in any dimension. Here is a further example of the insanity these elites cause today: ordinary citizens are held rigorously accountable down to the finest detail. Compare this to illegal immigrants, who are regularly placed on planes without any ID, Covid testing, vaccination, or masks. They receive social welfare payments illegally; they may work “on the books” only with forged Social Security cards = identity theft (or off the books, similarly illegally). They vote Democrat with impunity! and are encouraged and likely paid to do so. Do you think the lawlessness in cities does not extend to absence of policing of polling places and vote counting??
Given that the absence of the rule of law, as just described has filtered down into institutions, I cannot help but wonder if I would have been asked to resign were I African American, female, gay, trans, Native American, or a member of some other “oppressed” group. In affirmation of this purported victimization, much is made of “cultural competency”. It is required “education” in most employment settings. Do you suppose my Russian-sounding (but actually Ukranian) surname would have helped or hurt?? As well, Alcoholism/addiction is considered to be an illness, a disease. It is illegal to discriminate (that word again) against such a person because of that status. The way this works is that it makes such individuals nearly immune to consequences for their actions when it comes to employment. Is cultural sensitivity required as to members of the recovering community? I would think so, especially from the perspective of a rehab organization. In the recovery culture, transporting other suffers by car is widely practiced, indeed it makes a positive difference in the lives of many - both those who receive and those who give. Is it not a lack of cultural competence to punish me for doing what is routinely done within the recovery community? Were I a betting man, I would stake much on putting the question of the appropriateness of what I did to the entire population of patients in the institution and see if they believe I did wrong and should be asked to resign. I really wish I could to that….
It is important to me that you know I am at peace morally. My conscience is clear. When I took the patient into my car, I had nothing to hide, so other employees were well aware of what I was doing. Knowing the patient was a prior offender who had spent many years in prison, one nurse asked if I thought it was safe. Since I had established good rapport with the him earlier, I thought it was safe and proceeded. This and other nurses refused to cooperate with he administration - in an attempt to protect me - when the administration tried to investigate. When my medical director called me to inquire about the episode, I wrote her a two page, single-spaced letter, which gave a full and complete account of the 40 minute journey in my car, including the content of every conversation. Thus, they had no need of other facts; they were known only to me. In the letter, I acknowledged that this was irregular and that, in retrospect I should probably not have done it, as it did technically transgress a boundary; that it would not happen again. Nonetheless, despite the strong objection of my medical director, and her suggestion there be a lesser penalty, I was asked to resign. The prime mover was the director of HR, who demanded it for “consistency”. Discrimination in my favor based on recognized merit and crede ntials were deemed impermissible in the name of “equity”.*
*In light of events deemed ‘newsworthy’ by the MSM, I note that it is not uncommon for the same workplace rule (or laws in civil or criminal courts) to be interpreted strictly when it comes to Caucasian male citizens of European extraction. Other ethnicities and/or sexes/ or inter- or non-sexes/ or non-citizens, not so much. Cf. the above-mentioned treatment of US citizens versus illegal aliens. This is Marxist/Maoist class warfare aimed to divide and conquer. It is succeeding. It is likely to continue and may even come to resemble the Reign of Terror of the French Revolution. Beware, lest something like this happen to you, my children.