Accountability Increases Proportionally to Money
Once I realized this, it started to make a tonne of sense
Intern doctors go through hell.
All nine circles of Dante’s levels of hell.
Imagine working in a top-tier hospital but with a strange doctor-to-patient ratio. One doctor may be responsible for 50+ patients. Inpatients. Not outpatients. Such burdens are thrown at interns, who have had little to no time to practice.
However, because the degree of accountability peaks in a snap, from student to doctor, the amount one gets also has a steep change.
As a student, you could have financed yourself from your local hustles or received funding from your parents or other sponsors. You have a two-pronged job — study and satisfy the board of examiners.
After graduating, you’re a doctor, responsible for people’s lives. Accountability has skyrocketed. Money starts to whittle in.
It’s hard.
You have to adjust immediately or risk breaking down. Many quit. You won’t be first and definitely won’t be the last. Unless an asteroid lands on Earth the moment you quit.
This was the feeling I had when I started my internship. The demand is high. Your scanty skill set has to meet this demand. For several consecutive days. Twelve or at times 24 or even 30-hour shifts. Some even do 36 or 48-hour shifts. It’s taxing to the body.
I didn’t want to live this way.
It didn’t match my idea of efficiency. Life can have greater returns for applied effort. I imagined going back to do my masters. It meant more time at school, only to increase the time I spend in the profession, with more responsibility for a pay rise that doesn’t compute to the level of risk or effort I put in.
No, there had to be a better way.
After viewing it once I was done with my internship, certain aspects started to make sense. My thinking bandwidth broadened.
To whom much is given much is tested
I remember a case where a patient needed to have an emergency surgery after a recent Caesarian section had gone wrong. An excision of the uterus in the middle of the night was the next necessary step, but the consultant was not around.
In line with the hospital protocol, the consultant needs to be present for such procedures. The resident doctor made an urgent call, but the consultant was nowhere close. The doctor on the ground ran the risk of performing a surgery that could likely result in death because they were not authorized nor adequately skilled to perform such a case.
Hypothetically, if the team decided to take the patient to theatre, performed the surgery, and went well then they’d be praised for their quick response. But if they had a bad outcome, they’d be blamed for not waiting until the consultant showed up.
Such is the crazy reward system in health care. You’ll be praised for doing the same thing with good outcomes but chastised for doing the very same thing but with poor results.
This is a good example of accountability.
The consultant is accountable for every action done by the members of the ward. If a patient complicates, they are answerable. If the survival rates are high, they are praised.
In several hospitals, patients are admitted under the names of various consultants. Doctors on the ground cannot perform any other-worldly intervention without seeking the advice of these consultants.
This is accountability.
Thus, consultants earn much more than general practitioners.
Because to whom much is given, much is tested and much is expected.
If the outcomes are good, you’re paid. If not, you’re also paid but the situation could have been better. Sometimes, you pay the price. It can be hefty.
This was the underlying principle I was blind to. More accountability means more pay.
You feel the pressure, under more scrutiny
More accountability means more scrutiny.
If you mess around with someone’s husband, wife, child, or parent, a lawsuit could be waiting. Details will be scrutinized with a fine toothcomb. You have to be accountable for every action you take.
Sometimes, accountability is measured outside the context the person of interest was in. Consider Sully, the pilot who landed the airplane at the Hudson River.
During the hearing, the judges gave examples of models that could have landed the airplane at a nearby airport. Sully, an experienced pilot, felt otherwise. He had to think fast and safely land the passengers after an emergency incident happened when on air.
Typically, pilots run a checklist. He did that. No suitable option.
He then considered landing the plane on the Hudson River. The first-ever landing of such calibre. All the patients survived. But the hearing wouldn’t hear any of it.
Comparing models to reality should just be a guide. They are ideal standards out of touch with reality. Also, they are not accountable to anyone. Sully was accountable to the passengers and the airline he was representing.
Furthermore, it is difficult to tell if the absence or inclusion of an action should have tipped a certain event into a poor outcome. Complex systems cannot be adequately modeled to match reality. The map is no substitute for the territory.
But those tracing these actions often overlook this inescapable fact.
Surgeons too have checklists and are accountable for their procedures. Same to any member of the team in that operating room. But when they get slapped with lawsuits, the inquiry often forgets that patients and the team managing these patients are all complex systems — unpredictable.
Statistics will only guide you to the possible outcome, but that’s it. Percentages have little say on a single individual.
Scrutiny proceeds from accountability.
But like Sully, once you acquire experience, over time, you build specific knowledge. In schools, one gets general knowledge. In life, one gets specific knowledge.
Specific knowledge told Sully to land the airplane at the Hudson when general knowledge advocated otherwise. Specific knowledge tells the surgeon to withhold surgery when an ultrasound suggests the possibility of appendicitis but the patient elicits no symptoms or signs in keeping with such a diagnosis.
Because the accountability committee’s yardstick follows from general knowledge, it means specific knowledge can land you in problems.
Moving in a room full of no’s
Accountability gives birth to specific knowledge.
Specific knowledge will then be evaluated against general knowledge. In medicine, these are guidelines. But as Hardin once commented, words do not just provoke thought, they prevent it.
A guideline is just that — a guide. You can defend yourself if the outcome is bad if you stick to the guidelines. But if you attempt to do something outside the guideline and have the same outcome, the baseline assumption is if you had stuck to the guideline, you’d have had a better outcome.
Specific knowledge can get you into trouble.
Accountability also has more money.
If they are coming at you with a lawsuit, they will assume you have a lot of money with you. The penalties can be rough.
In such a room, however, you can still continue moving despite the disapproval.
You might hate him, but Donald Trump has built a name. There is no other Trump besides the guy. And the controversy that runs with his name is palpable when you bring it up. The same thing goes for people like Kanye West or Elon Musk.
Hatred is also awareness.
So it’s also another way you move in a room full of no’s.
It allows you to make more from it if you’re smart about it.
I looked at the list of the top 10 richest people in the world. Almost all of them have had a bad reputation at least once. Some receive the backlash almost daily.
But all of them are accountable.
ALL.
Look at the companies they represent. They are accountable to the people who use their products and services. When Berkshire Hathaway has a dip in its shares, you don’t point your knife at the employee. You ask Warren Buffet what the problem could be.
If Microsoft has an issue with its software, people look to Bill Gates. Not the current COO or some department director. If Google launches a product that has potential harm, we think of Larry Page and Sergey Brin.
When Beckham was the captain of England and acted out against the Argentinian player and received a red card, people considered him as the reason for England missing a chance of progressing to the next stage in the 1998 World Cup.
People expected Messi to take the country to World Cup victory for years before he eventually did it. It resulted in a heavier burden for Cristiano Ronaldo.
People looked to Michael Jordan, Kobe Bryant, LeBron James, and Steph Curry to win championships.
These legends have a tonne of accountability.
Money follows.
Despite the hate, accountability progresses and rewards. Thick skin is necessary.
I hear a lot of ‘I want to be rich’ from many. But it comes with accountability. If handling such pressures is an issue, you’d have wished differently.
Bruno Mars wanted to be Billionaire, so freaking bad, but as B. I. G said, more money problems. More problems, in this case, is accountability which you’d have no control over. It can flip whichever side. If it falls on the bad side, you have to answer to the people you’re accountable to.
As I close…
Accountability and specific knowledge go hand in hand.
Specific knowledge is only, ONLY, built through experience. The more you have, and the more accountable it makes you, the more people will be willing to give you their money.
I could get more money by going back to school and becoming a consultant specialist. This goal is not efficient by several standards. I, however, understand how it can make many people aim to specialize. It does result in more money.
Not because you’ve read more, but because you’ve increased your level of accountability.
PS: I have a platform with courses run by people who have built specific knowledge in their field and are willing to share their seasoned nuggets. Check out The One Alternative Academy. I’m also accountable for delivering quality content to 45+ others every week, for free though.
