The Awful Price of Winning at any Cost

Trust is Essential for Success in Treating Chronic Illness

Competition and winning is deeply embedded in American culture. Competition and winning are fine. They stimulate progress and better products when it is our servant. That is not where we are. We have changed. At every level of endeavor including medicine, we now have a culture of winning at any cost that has become our master. I hate it and I want no part of it.

When I was a child, I loved history and read many books about the early leaders of this country. They inspired me. George Washington, our first commander in chief, was notable for his character and integrity. "Poor food—hard lodging—cold weather —fatigue—nasty clothes—nasty cooking—vomit half my time . . ." wrote Dr. Albigence Waldo about the tribulations of Valley Forge. Washington desperately urged Congress to send him food, but instead the Congress advised him to steal food from farmers nearby. Such theft might have solved the short-term problem, but it failed Washington’s character test. America could never endure, Washington believed, if it could not earn the respect of its own citizens. He angered Congress by rejecting its advice and promising instead to hang any soldier caught stealing food.”.  Our military academies strive to replicate that character. “ A cadet does not lie, chest, or steal or tolerate anyone who does.” Abraham Lincoln’s nickname was Honest Abe. I understand the dark side of our history, but these are values that were the foundation of our good side.

Our culture has changed dramatically in this regard. When I played high school football, I was a lineman on offense. Our coach taught us that holding was against the rules and there was a fifteen-yard penalty for breaking that rule. I did not hold anyone intentionally. I played some defense, and I don’t remember being held very often. My grandson is a good defensive lineman at a large high school. I go to watch some of his games. He is held on play after play. It is obvious. You can see it, and the penalties are seldom called. The rule has not changed.

Here is the current rule on holding and a comment about it. “Offensive players are not allowed to grab onto ANY part of their opponent's body or equipment (be it their shoulder pads or jersey). A lot of offensive linemen try to get away with grabbing the inner part of a defender's shoulder pads because it can be hard for refs to spot this. However, that is illegal by the rule book as well.”

It’s not just that the players decide to do this, their coaches teach them how to do it and not get caught. The pressure to win is huge but there is an awful price to pay. Team sports can teach valuable life lessons, but winning at any cost is a terrible lesson to teach young people. Character and integrity are more important than winning. Once we leave school, winning is defined by money and power in this country and too many will do anything to get it. Lying and cheating to win are pervasive and trust cannot survive in that environment.

Of all the professional and business endeavors, trust is especially essential in our military and medicine. These are life or death pursuits. They teach a cadet “does not lie cheat or steal” because in combat, you must be able to rely absolutely on the integrity and character of those who are fighting beside you. It is the same in chronic disease management in medicine. The key to achieving optimal medical therapy is developing a long-standing trusting relationship with the people you serve. It takes time and integrity to earn that trust. If patients don’t trust you and believe that you care about them, they will not follow your advice. Our healthcare system current system is not designed to provide the time to develop that trust and too many medical leaders are willing to win at any cost.   These are the values we must promote as we build advanced primary care teams to provide optimal medical therapy for chronic diseases. We must be trustworthy. It has to start somewhere.