Henry Kissinger famously stated during the Nixon years that “Power is the greatest aphrodisiac.” More than a century earlier Abraham Lincoln noted that “Nearly all men can stand adversity, but if you want to test a man’s character, give him power.” Every hospital as an institution has a power structure among its medical staff. Powerful members of a medical staff are never the subject of sham peer review and rarely the subject of any kind of meaningful peer review. Armed with the control over the peer review process and the statutory immunity and other protections, medical staff leaders wield an immense amount of personal power over those on the medical staff that the view as threats, competitors, or of a lesser station that need to be put in place because of racial or sexual bias or just because they get a level of glee out the use of power to “kick down.”
A huge body of research -hundreds of studies - shows that when people are put in positions of power, they start talking more, taking what they want for themselves, ignoring what other people say or want, ignoring how less powerful people react to their behavior, acting more rudely, and generally treating any situation or person as a means for satisfying their own needs - and that being put in a positions of power that they are all acting as jerks.
Sutton, The No Asshole Rule: Building a Civilized Work Force and Surviving One That Isn’t. Hatchett Book Group. (2007)(Kindle location 905-907)
The studies tend to show that power leads to objectification of subordinates and colleagues making the powerful “prone to self-interested, impulsive behavior, be it inappropriate consumption of public goods or aggression.” Guinote & Vescio, The Social Psychology of Power, The Guilford Press. (2010) at 196. “The experience of power short-circuits the very tendencies toward effective social engagement that group members seek in teir leaders - a paradox of power. “Id.
In hospital settings power historically has been focused on big admitters, in hospital based physicians, and in long time officers of the medical staff who pass critical roles of chief of staff or members of the Medical Executive Committee back and forth among a favored few. Those who are typically victims of the inappropriate exercise of institutional power tend to be new members of the medical staff, women, minorities and foreign born physicians who do not assimilate as easily into the social structure and organization of the hospital institution. There is a hospital in Texas that had a shelf in the medical staff office referred to by most of the medical staff as the “sand bunny” shelf for doctors from India, Pakistan and the Middle East, for ease of access during peer review proceedings.
It will come as no surprise that some male doctors are sexist and very much resent the intrusion of women into what used to be a male dominated profession. There are also some doctors who harbor economic resentments because women physicians tend to be more attractive to female patients and foreign born or minority doctors are looked upon as inferior but competing for patients in their turf. Loners and those who tend to keep to themselves and eschew the playing of institutional politics are the most at risk.
Although, ideally every physician should be reviewed fairly and on their merits in the peer review process, but the system puts so much power in the hands of a few to “bank” (report to the National Practitioner Data Bank) a physician and drastically effect his or her career that fairness and “laissez faireness” cannot be assumed. All physicians on a medical staff for pure self protection need to pay attention to the politics of the institution and to build alliances with important physicians who can help provide a level of protection and shelter from those with power who are inclined to use it because they can.
Hospital administration will generally accede to the power structure on the medical staff either out of fear of disruption or by my manipulation of those institutional powerful doctors that they are dependent upon to keep the institution afloat. There are hospital administrators and physician leaders that make it their business to create a collaborative interaction in their hospitals but they are rare. Many are unable to lift others without feeling diminished themselves. If they are picking on you and you have no allies and mentors consider moving on before they commence the peer review process and render you unable to leave because the mere fact of your leaving while under investigation is itself reportable to the NPDB.
Comments