Core Values and the Role of The Vascular Surgeon

By Frank J. Veith, M.D.

Core values are the character traits or ethical principles that govern how individuals interact. Institutions also have core values, collectively known as a corporate culture, which is almost totally dependent on the character traits of the institutional leader or leaders.

Positive core values include honesty, integrity, dependability, loyalty, courage, team spirit, altruism, appreciation for others, long-term vision, and placing group interests above self-interest. Negative core values include dishonesty, unfairness, exploitation, maintenance of fear, and pursuit of self-gain at the expense of the interests of other individuals and the group.

In modern American society, there are too many examples of individuals or organizations in which negative core values outweigh the positive. Examples include the inability of Congress to enact campaign or tort reform and the excessive compensation for CEOs of poorly performing companies. In each case, self-interest wins out over what is right or best for others.

Why are core values important to vascular surgeons? Beyond the importance of a vascular surgeon's core values to family and close colleagues, vascular surgeons live in a complex medical environment. We have myriad professional relationships with other people and institutions.

Although the success of our relationships is governed by our core values and by those of the people with whom we interact, I would like to focus this column on the importance of the core values of the institutions in which we work. These include hospitals, medical centers, clinics, medical schools, and our professional societies.

These institutions have a right to expect vascular surgeons generally will have and display positive core values. In return, we have the right to expect these institutions to have and display positive core values to us and to other physicians with whom they have professional relationships. Unfortunately, in today's dollar-poor health care environment, this often does not happen.

The behavior of an institution often is determined by what is good for its financial interests or the selfish well-being of its leaders. In this circumstance, the interests of individual physicians are disregarded, and more importantly, the well-being of patients and societal interests are poorly served.

Examples of these corrupted core values are common. Overpaid executives of some HMOs are one example; they receive obscene salaries without adding value to the system. Their main goals seem to be to deny patients access to good care and to find ways to pay physicians poorly. Some physicians respond with unnecessary procedures to make up the financial shortfall.

Then there are those hospital executives who fail to compensate physicians fairly to improve institutional balance sheets to the point where these executives then can claim excessive compensation for themselves. The bad core values of these hospital executives have a negative impact on the morale of physicians working in these institutions and, once again, patient care suffers.

What can we, as vascular surgeons, do to fix this negative spiral of blighted core values? First, we can recognize the problem and refuse to allow our own core values to deteriorate, resisting the temptation to perform unnecessary procedures to compensate for decreased incomes brought about in part by institutions with poor core values.

Second, we should make a greater effort to become leaders in medical institutions and organizations to restore good core values.

And, finally, vascular surgeons should influence our societies and associations to adopt core values that serve our members and the public fairly and benevolently within a health care system in which positive core values seem to be disappearing. Some group has to reverse this trend--perhaps this should be the vascular surgeons.