Physician Grounded; Patient Care over Self Care; The Imperative of Patient Care
Physician is Grounded Involuntarily
The long list of causes of Physician Disruption just got longer. Three days ago, Dr. David Dao was forcibly ejected from United Airlines Flight 3411, making news that went viral globally. Much has been written and said about the way the United Airlines handled the entire incident, from the crew bookings to the police action to the CEO’s attempts to support his company. There also has been some notable commentary about Dr. Dao, who suffered his own disruption event more than ten years ago, when a series of unfortunate events led to his temporary loss of licensure.
But I’m not seeing any commentary about Dr. Dao’s psychology as a devoted doctor and what drove him to refuse to be removed from the plane. It’s important to examine this, because this is the mindset that drives dedicated physicians to put themselves in very high risk situations every day.
First, let’s deal with the issue of the overbooking. Apparently the plane wasn’t actually overbooked. The airline needed to get a crew to Louisville, and apparently appealed to some passengers with bribes of cash. But Dr. Dao was not to be bought. He had a higher calling, an urgent need to get back home, where he was scheduled to see patients the next day.
I know that feeling personally, traveling by the seat of your pants, where not arriving home in time means chaos and mayhem for your clinic and your patients the next day. But when you’re a doctor seated on a plane, you’ve already passed that point in the flight where you worry. You arrived on time to the airport. You made it through security and got the the gate ok. The flight wasn’t cancelled, or delayed. You boarded, stowed your stuff, got seated and you’re feeling grateful that you’ll be able to make it back in time to grab a bit of sleep before hitting a crazy day in clinic. Maybe you’ll even sleep a bit on the plane just in case.
Prioritizing Patient Care over Self Care
At this point, there is nothing keeping you from your patients, and you’ll be spared all of the turmoil and damage that one missed clinic will cause. You can relax. It’s all downhill from here. The last thing that should happen, that can happen, is being ejected from that seat. Because you know what hell will follow.
When a physician has lost the ability to care for patients, he or she will do nearly anything to get back there. Something about patient care is so deeply rewarding that it forces physicians to take on enormous personal risk just to be able to continue the privilege. I’ve been there. I know exactly how hard it was for Dr. Dao to fight back from that place of despair and sadness, of shame and embarrassment. To be back in the clinic, that’s a victory.
Yes, maybe the airline did have the right to forcibly command their own territory. But all you have to do is watch the videos of his extraction to see in his eyes why he was so reluctant he was to be removed. Not because he was spoiled or insolent — no, that urgency, that insistence not to be booted was because of the pressure of his clinical obligations, with the lives of dependent patients hanging on his insight and wisdom. Resistance was futile, but it was instinctual.
The Imperative of Patient Care
Putting myself in Dao’s shoes, I can sense what he was feeling — the impending doom of missing out on a clinic full of patients. When you know those patients are depending upon your presence, you feel a deep urgency, insistence and unwillingness to compromise that compels your movement forward. Even more so when you’ve tasted loss like Dr. Dao has — the loss of many years of patient interactions because of one mistake, one Disruption that took him away from his career.
After such a loss, you savor patient care like never before, especially when you know that missing a busy day in clinic can anger those very patients. Angry patients have a much greater impact on your ability to continue to practice when you’re under the scrutiny of the licensing agency, the Physician Health Program, and layers of predatory regulators. You’ll almost eat your arm off to avoid angering your patients when you’re under the thumb.
A Cheap Shot Became a PR Misfire
So it’s beyond disappointing and just plainly insulting that CEO Oscar Munoz would even tangentially bring Dr. Dao’s challenges from his past into the discussion. There isn’t a single physician out there who hasn’t had some sort of difficulty, some issue that he or she has tried to leave behind. To bring Dao’s past into the equation is an example of Physician Devaluation, a technique that has been perfected by hospital executives as they bid aggressively for cheaper physician labor.
It was a risk mitigation move, but it’s interesting to see how it’s backfired. The scorn of the herd has had an impact on United’s stock, and Chinese citizens are taking us to task for human rights violations. Congress is involved and investigations are opening. Even so, Munoz continues to dissemble. It’s fairly obvious that he knows that he will win after everything blows over and the company demonstrates the proper amount of public remorse.
The Deck is Stacked
To make matters worse for Dr. Dao, the current statutes make it almost impossible for a passenger to win a lawsuit for being mishandled, given that the industry has fought hard for regulations to protect their corporate interests. Again, this mirrors the current environment in health care, where hospitals enjoy an unbelievably unfair advantage over physician staff. Just as United Airlines manhandled Dr. Dao out a one-way exit, hospitals manhandle scores of physicians every year to their exits through the use of Sham Peer Review tactics.
So while both the airlines and hospitals have been getting away with mob-like actions in the dark, it’s heartening to see so many protests against the unfairness of the treatment of this devoted physician. Dr. Dao’s insistence to keep his seat and stay on the plane was the response to a deep-seated emotional need to be a good doctor and tend to his patients. He should be commended for his commitment to them and his efforts to rebuild his career.
United Airlines can Still Win the Right Way
In this draconian medical environment, even the smallest bureaucratic mis-step can cause far-ranging damage to a physician’s career. Who knows just how many adverse actions may come downstream from his patients who missed out on his care this week? United Airlines ought to settle with him to make it right, and they should factor in the exacerbation of damage to his career when estimating his compensation. Anything less will send the signal to thousands of physicians that United Airlines does not deserve our travel investments, and our dollars will go elsewhere.