Thursday, September 24, 2009

When does the leader have a conflict of interest?

I saw an item on the Internet about a study of doctors’ attitudes about ordering treatments and conflict of interest. I don’t have a link to the item, but I will keep looking for it and hopefully link it later on.

Here is the essence of the item. Some doctors were asked to decide on a treatment for a fictional patient. They were given a set of symptoms and test results. They were given the option of two treatments: one a tried and tested approach; another a new therapy that did not have a significantly greater likelihood of succeeding but that they could bill for a higher amount. Which did they choose? Overwhelmingly, the more expensive therapy. Okay, now, the question was posed with their spouse as the patient. Which did they choose this time? Overwhelmingly, the first one. I don’t know if it was the same group of doctors or a different one.

So, when they have no personal connection to the patient, they chose the one that will make them more money, even if it does not help the patient any more than the other one. When they have a connection to the patient, they go for the tried and tested. Clearly, if doctors have a monetary interest in the way they decide what treatment patients get, then it becomes a conflict of interest.

We trust our doctors but we don’t really know what challenges they face in who treatment to order. We don’t know what conflicts they have along the way. The point I want to make, however, is that we are all conflicted to some extent. Our leaders are especially conflicted. They must often decide whether to do something that is good for the organization versus what is good for them. We have our own battles with those types of challenges.

When I do training, I have to balance how much effort to put into any given session versus how much I’m going to get from it. However, the trainees don’t know that. They don’t know if I have given them everything I could or did just enough to get by. The real test of leadership, in this case, is to figure out what to do when no one else knows. As the old saying goes, integrity is what you do when no one is looking. As patients, we don’t know whether the doctor is ordering something for us because it is the best thing for us or for his checkbook. Likewise, we don’t really know if our organization’s leader is ordering us to do things because it is what he/she thinks is best for us (the organization) or for them.

This just goes to reinforce that trust is part of what keeps people working with you and that your integrity is what they hope keeps you there, too.