The primary principle of being a physician isn’t “do no harm.” It’s “stay out of others’ affairs.”
You won’t discover it in ethical manuals. It’s absent from any structured coursework. However, inquire subtly, discreetly—and most experienced medical professionals will share a similar sentiment: those who interrogate too much don’t endure long.
You grasp this not through lectures, but by watching. A colleague highlights a safety issue. A memo is drafted a bit too candidly. A student expresses unease during rounds. The subsequent events are seldom dramatic. No one is terminated. Yet, they face exclusion. Reassignment. They’re invited for a coaching session focused on “tone.”
Eventually, the message resonates with everyone. The system doesn’t need to stifle you. Your colleagues will handle that for you.
We label it professionalism. Yet social psychologists may refer to it as norm enforcement. The mechanism by which groups preserve their identity through subtle retribution against dissent. Or pluralistic ignorance. When everyone internally doubts what’s occurring, yet refrains from voicing it due to the belief that others concur. Or the agentic state. That nuanced transition where you cease to regard yourself as a moral agent, and begin seeing yourself merely as a gear in the machinery.
It’s not that individuals lack concern. It’s that they’ve recognized that expressing care openly carries professional risk.
When healthcare providers cannot safely articulate harm, patients are not made safer. They simply cease to hear the reality.
The cognitive dissonance initiates not when you observe harm. It begins when you are conditioned to keep it to yourself.
Healthcare has honed its ability to govern this dissonance.
Ethics consultations are accessible—primarily post-event, and only after the terminology has undergone thorough risk management approval.
Incident reports are promoted—except when the flaw is structural, at which point the directive is to “keep it internal.”
Psychological safety presentations circulate—but articulating an inconvenient truth during morning rounds can still earn you a reputation for being “not a team player.”
We assert our desire for transparency. What we truly want is plausible deniability.
New healthcare providers frequently assume their role is to advocate. To pose tough inquiries. To acknowledge what they perceive.
However, advocacy comes with a cost. Consult any whistleblower. Any nurse deemed “disruptive.” Any physician quietly dismissed from a committee for highlighting issues regarding a patient death.
There’s a protocol for managing these individuals. It commences with wellness outreach. It concludes with peer review. The specific verbiage may differ, but the narrative structure is consistently the same: The issue isn’t the content of their statements. It’s the manner in which they expressed them.
Hospitals are not deficient in mission statements. What they lack is tolerance for moral clarity.
Consequently, the culture evolves. We discuss harm using passive voice. We describe preventable injuries as “unfortunate outcomes.” We advise new clinicians to be team players—which frequently entails learning when to remain silent.
We normalize silence by labeling it respect. We reward emotional detachment by calling it resilience.
The genuine tragedy lies not just in that individuals suffer harm. It’s that clinicians learn to recount those injuries in a fashion that ensures everyone’s safety—except that of the patient.
And when the harm is sanitized, the moral injury persists. It proliferates. Quietly. Systemically.
There is a reason numerous clinicians articulate burnout in terms of numbness. Because numbness is the consequence of being compelled to feel everything yet say nothing.
Thus, the cardinal rule of being a doctor isn’t “do no harm.” It’s “don’t observe too closely.” Or if you do, keep it to yourself.
If you wish to endure, that is.
After all, the most perilous entity in a hospital isn’t a negative outcome. It’s someone brave enough to name one.
Jenny Shields is a licensed clinical psychologist and nationally certified healthcare ethics consultant who specializes in clinician burnout, moral distress, ethical trauma, and intricate psychological assessments. Located in The Woodlands, Texas, she operates a private practice—Shields Psychology & Consulting, PLLC, where she provides confidential counseling, consultation, and education for physicians, nurses, therapists, and healthcare leaders across the nation. Dr. Shields is dedicated to transforming the dialogue in healthcare from individual resilience to systemic ethical reform. She is associated with Oklahoma State University and routinely shares insights through public speaking and writing, including contributions on Medium. Her professional presence also spans platforms such as LinkedIn, Google Scholar, ResearchGate, the APA Psychologist Locator, and the National Register of Health Service Psychologists.