Assuming responsibility

The thing that decided the course of my life as a health professional was an article on KevinMD.com, a website of resources for physicians. The 2013 article was by Lara Devgan, called “Everything’s my fault: How a surgeon says I’m sorry.” It tells of the author’s personal experiences with a mantra taught to her early in training: “I assume full responsibility. It won’t happen again.” The author illustrates how learning this attitude helps in anticipating and preventing issues in patient care, as well as in managing the inevitable fallout when accidents happen. Everything is the surgeon trainee’s fault, whether a phlebotomist loses a test tube of blood before it makes it to the laboratory, or if a poorly instructed patient eats right before surgery, when she is supposed to be on “nothing-by-mouth,” and thus has her surgery canceled. “When something went wrong with one of my patients,” the author wrote, “whether it was his fault, my fault, or someone else’s—it was always my responsibility.”

It made sense to train this way, because our education in legal medicine was riddled with stories of the surgeon as a “captain of the ship,” which describes how a surgeon is liable for all actions conducted in the course of his operations, even if the actions were not his own. The doctrine recognizes the vulnerability of a patient, and places the total burden and liability of care on the primary surgeon. “When a person trusts you with his life,” Devgan continued, “the buck stops with you.”

This motto, though yet imperfectly applied in my personal life, signified a worthy goal, which was always twofold: to have the leadership, humility, and accountability to be able to take full responsibility for both my actions for those under my team, and to have the moral and intellectual rigor to strive to prevent complications in the first place. While the “captain of the ship” doctrine is no longer held absolute and has declined in use and adoption, it sets a standard of behavior and responsibility for leaders of such teams. It was an inspiring idea to think that what separated great surgeons from the mediocre ones was this clear-sightedness, this sense of responsibility and humility.

Curiously, bits and pieces of this article kept running through my mind as I listened to the UN General Assembly speech of President Duterte. A collective sigh of relief was made by all, no doubt, when we saw that this speech at least was coherent and calm, a contrast to the ramblings, incoherences, and curses we have been treated to over the course of quarantine every time the President addressed the nation.

And yet, while the words were serene, the content was not. He struck once more at the ill-defined enemy, “terrorism,” and poetically put the blame of “oozing blood” on those detractors that his administration is so fond of red-tagging, saying these have “weaponized” human rights. He has conflated the protection of human rights with the fight against illegal drugs and criminality, and glosses over transgressions against the paramount right to life. While (perhaps rightfully) saying nothing of the government’s lackluster COVID-19 response under his leadership, he had the cheek to praise frontliners and call for “coordinated international plans and efforts to pursue a common purpose”—things that are sorely missing from our own COVID-19 efforts. He spoke of “the majesty of the law,” as though those favored by this administration do not continue to enjoy impunity, walking free despite the grossest transgressions.

Listening to the speech reminded me of a hypothetical surgical trainee, standing in the middle of a morbidity and mortality conference, willing to blame everything but himself for a patient morbidity. While good surgeons must bow and critique their own technique, their lack of foresight or their poor decision-making, bad leaders can stand in front of other sovereigns and blame everyone but themselves. One wonders if we will ever have a leader who can own up to their “morbidities” and say, with full sincerity, “Everything is my responsibility.”

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