The Word on the Street: No Harm, No Foul?

August 7, 2007

One of the most significant differences between healthcare providers and Wall Street professionals is that the bankers on Wall Street seem to have an intrinsic understanding that in order to...

One of the most significant differences between healthcare providers and Wall Street professionals is that the bankers on Wall Street seem to have an intrinsic understanding that in order to realize gains they must take risks. Conversely, the attitude among decision makers in healthcare seems to be “I cannot do anything wrong if I don’t do anything.” Some of this aversion toward taking risks stems no doubt from a misinterpretation of the Hippocratic Oath. The mandate “first, do no harm” should not be understood to mean “first, take no risk.”

Spend a few minutes reflecting on the tremendous achievements that would not have been realized were it not for some brave adventurer who was willing to take risks. Columbus would never have discovered the New World without taking risks. Pasteur, Einstein, and Edison all made remarkable discoveries by taking risks. The scorn and

ridicule they endured increased the potential consequences of failing. In fact, can you name a single great breakthrough that was accomplished without taking a risk?

What is the consequence of a complete unwillingness to take a risk? A complete lack of progress. Doing anything new and innovative carries with it some element of risk. Every time a new computer application is installed at a hedge fund, there is a chance that the system will make things worse, not better. Although new systems are thoroughly tested before they are deployed, if the goal is to eliminate risk completely (which is impossible, of course), then the new system has to be tested for months, or even years, before it goes live. Of course, that begs the question, “What happens while the new system is being ever-so-thoroughly tested?” Is there a risk in not deploying the new system?

Certainly there is. Time introduces all sorts of new risks. For example, time allows competitors an opportunity to build and deploy systems of their own. Perhaps the competitive advantage they gain while our hedge fund is testing the new system causes hundreds of customers to switch from our fund to theirs. It is highly possible that the consequences of not taking a risk are far greater than the consequences of taking a risk.

A few years ago, there was an interesting little movie called Moonstruck starring Cher (as Loretta) and Nicholas Cage (as Ronny). Ronny was a wild and mercurial young guy who was trying to woo an older, more mature Loretta. Loretta had just come through a trauma of her own and was much too cautious to start anything with this crazy kid. Finally, in a fit of frustration, Ronny says to Lorretta, “At your age, playing it safe is the riskiest thing you can do.”

What’s true in personal relationships can also be true in the business world--playing it safe (ie, sticking with the status quo) sometimes turns out to be the riskiest course of action one can take. The same also goes for physicians. Which is riskier: sticking with an existing course of treatment that is failing to produce any improvement in a patient, or opting for a less-conventional approach?

Given the serious problems present in healthcare today, I believe that the worst action we can take is no action. When a Wall Street firm is faced with a new problem that threatens its viability, it acts. This involves doing something new, which inevitably involves taking a risk. This is the way of life on Wall Street, where hesitation can be riskier than action. When new approaches are proposed in healthcare (eg, pay for performance, consumer-driven healthcare, universal health insurance, the Physician Quality Reporting Initiative), physicians’ reaction is often to run for the lobbyists to see if we can stop the lunacy. Not all new things will be helpful, that much is clear. But rejecting all new initiatives because they represent risk is the best way to guarantee that the fundamental problems plaguing healthcare will never be resolved. To quote one of my coal miner father’s favorite old colloquial expressions: “For hell’s sake, do something!”

Dr. Kennedy is the President and Chief Executive Officer of RemedyMD.