Impartial

For the past two weeks, I have been reading Rafe Esquith's book Teach Like Your Hair's on Fire. I learned about the six levels of moral development, as first proposed by the Jean Piaget and then simplified by Rafe. These six levels seem simple. Yet implementing them is anything but simple.

You might be less eager to learn the basic levels, but I have to briefly mention all these six levels - one by one. Level I thinkers simply act out of fear. Most children do. They do homework to stay out of trouble. To move up the ladder, we can use Level II thinking and do homework for reward such as the homework chart gold stars. Can we do better? Yes, Level III refers to the stage kids learn to do things to please people: "Look, Mommy, is this good?" And on the path to moral reasoning, children should be taught to reach Level IV: follow the rule. And it works. That's why we have classroom rules or the Ten Commandments.

According to Rafe, we should aim higher like Atticus Finch in To Kill a Mockingbird: become a Level V thinker and achieve a state of empathy for the people around. To paraphrase Atticus, You never really understand a person until you consider things from his point of view ... until you climb inside his skin and walk around in it. The most desirable level, however, is the Level VI (the Atticus Finch Level) where a thinker has a personal code of behavior. He does not base his action on fear, or a desire to please someone, or even on rules. He has his own rules. There will be times when the Level VI thinkers become heroes by not following rules. Think Martin Luther King Jr. Or Mahatma Gandhi.

A few weeks ago a friend of mine who is a passionate doctor confessed that he would go the extra mile delivering "better" attention to certain special patients or families. It's one of the worst kept secrets of doctors who are supposed to treat all patients equal. As a clinician serving the public sector, understandably, I should be impartial and avoid favouritism.

The hard truth is, most doctors do have favoritism. Many a time when our patient and family are nice. Remember Level III? Nice patients deserve better care, don't they? Sometimes, out of fear (think Level I). Many doctors learn the hard way that it's rarely a good idea to finish a clinic consultation too quickly when the patient enters the clinic with the whole family. You can call this a veiled threat of complaint. Or call it "squeaky wheel gets the grease" phenomenon, as what Dr. Detsky wrote in the Journal of the American Medical Association some years ago. Pretending that this phenomenon is not so is probably not helpful, in Dr. Detsky's word, and raises the next question - is it wrong?