UPFRONT

Accountability

JASON S. SLAKTER, MD

These are truly remarkable and turbulent times in the United States. The radio, television or newspaper screams out news of a controversial and contentious presidential election, an ongoing and unpopular war, soaring energy prices, and most recently the potential for the worst economic crisis since the Great Depression. It seems that each day some new information comes forth or a revelation is made that adds to the complexity and seriousness of these situations. Just how is it that we got into such a mess and seemingly so quickly? To me, it all comes down to one simple concept: accountability.

Looking at the financial crisis that we face today, no one wants to take responsibility — certainly not the heads of the major financial institutions who allowed their companies to make investments and engage in lending practices or credit default swaps that gambled the very viability of their firms. Nor do we see the Bush administration nor the Congress step forward and accept their share of blame for the lack of proper oversight, regulation and guidance needed to ensure that these events did not unfold. Of course, it is unfair to simply fault the people at the top. Individuals trying to make a quick profit on selling properties using subprime or adjustable rate mortgages saw the opportunity for a fast dollar in spite of the potential risks involved. Even the homeowners and the brokers who advised them, who knowingly entered into financial arrangements for houses priced well above their means simply because it was the new norm, made unwise decisions and should shoulder some of the responsibility.

ACCEPTING BLAME

What is remarkable, with all of this blame to go around, is the rarity of anyone stepping forward and saying, "I'm sorry. I made a mistake. I should have known better." Instead, we see talk of bailout, rescue plan and government assistance. To me, this lack of accountability is particularly disturbing, perhaps because of our profession.

As physicians, we are trained from the very beginning to take responsibility for our actions. We are expected to maintain the highest level of education, training and certification in our specialty, we perform thorough diagnostic evaluations of our patients, provide them an understandable explanation of their condition and treatment options, and of course maintain the highest level of skills possible to deliver these therapeutic interventions. Ultimately, every aspect of patient care revolves around our willingness to accept responsibility and to be held accountable for our actions.

Perhaps if the political and financial institutions took a lesson from physicians in accountability, we would be better off today. In the end, all Americans will be forced to shoulder the burden of the poor decision-making that led to our current situation. Unfortunately, as is often the case, we as doctors may shoulder more than our fair share of the cost of resolving this crisis.