Credibility the Cure?
“Here Harry,” S.Q. Lapius commanded as he tossed the magazine into my lap, “read this.”
I picked up the magazine and started to read the lines that Lapius had demarcated with a marker.
“Well?” Lapius said, impatiently.
“Well what?” I answered. “Read the piece.”
“I am reading the piece, Simon.”
“But you are not reading it out loud,” S.Q. Lapius complained.
“But you have already read it.”
“Of course, but I want to hear it again.”
I read aloud, from the Talk of The Town column of the New Yorker Magazine, December 17, 1973. It was all the more remarkable, because it was only the 14th of December, 1973. But I read aloud anyway,
“…Credibility is the modern version of candor. Candor entails truthfulness, but credibility does not. Credibility is the public relations version of truthfulness. It is truth’s ‘image’. And, like any other image, it can be manipulated and faked. Probably none of us should be surprised when politicians offer us credibility instead of the truth. What is odd is that audiences sometimes seem to be satisfied…”
“A nice distinction, eh, Harry,” Lapius said, after I had finished.
“Very nice,” I agreed.
“I always like The New Yorker,” Lapius confided, as if I didn’t know, since he had me read excerpts such as this from the different issues of the magazine almost weekly. “It’s sort of a cerebral decongestant. The New Yorker does to the mind what Dristan does for the nose. Clears away congestion.”
I found myself reluctantly forced to agree with Lapius. I enjoyed the distinction drawn between candor and credibility, between the truth and believability. It is what I had been trying to put my finger on for months. The nation and its institutions, for a long time now, from the presidency down, had been floating trial balloons of credibility. Advertising agencies had been creating images of credible products to the extent that we have become used to the appearance of truth in place of truth itself.
I mentioned this to Lapius. “Yes, Harry, of course. You understand the point. We have become overly concerned with the representation of truth. I see this in hospitals all the time. Weekly I am called to the medical records library to sign out charts. While doing this I must affix my signature to orders that I neither gave nor sanctioned at the time that a resident on duty ordered a drug for one of my patients. This is because some higher accrediting authority has proclaimed for reasons unknown, that the orders of all resident physicians must be countersigned. This is obvious fraud, sanctioned by the hospital administrator, the board of trustees, the state and federal authorities.
“I must also sign all justifications for prolonged utilization of the beds by patients and back date my signature. Again, a fraud, sanctioned by the powers that be.”
“The fact is,” Lapius sighed, “that we have become hypnotized by the appearance of records and charts, as if, in fact, they represented reality, and we have been coerced to commit minor perjuries in writing to confirm a demand by authorities that dole our accreditation, or other inspection agencies. Everyone in the hospital conspires to perpetrate this type of deception. The end result is that more money is spent taking care of patient’s charts, than of the patients themselves.”
“Have you any suggestions?”
“Yes, of course. To thine own self be true. The doctors should stop being accessories to the trickery.”
“But when there is the possibility that accreditation will be withheld, that third party will withhold funds.”
“Sheer blackmail, isn’t it Harry. We are asked to yield ground on our morality and ethics to satisfy our leaders and bankers. Physicians should decline to become partners to this chicanery.”
“But Simon, be reasonable. If we don’t countersign resident physician’s orders, then we will be called at all hours of the night for minor things that the house physician can take care of.”
“Wouldn’t it be better to admit the truth of things. That the resident physician is empowered to treat hospitalized patients in an emergency.”
“But if you don’t countersign an order, then the physician may be held liable if a patient succumbs, not necessarily because of treatment. Your signature is admission of your responsibility in the case.”
“And if I do sign, than I am taking responsibility for an act over which I had no authority. Actually, the system is a fraud. It should admit the truth of things. That on occasion a resident physician will have to take responsibility for patient care. That is the bald fact, and no amount of post dated countersigning alters it. It only alters the appearance of fact.”
“In other words, come what may, you opt for candor in place of credibility.”
“Then how come you’ve adjusted our scale so it is shy about three pounds?”
“That’s different,” said S.Q. Lapius.