The first rule of being a doctor is not “do no harm.” It’s “mind your own business.”

You won’t find it in the ethics textbooks. It’s not part of any formal curriculum. But ask around—quietly, privately—and most seasoned clinicians will tell you the same thing: the people who ask too many questions don’t last long.

You learn this not from lectures, but from observation. A colleague flags a safety concern. A note is written a little too honestly. A student voices discomfort during rounds. What happens next is rarely dramatic. No one gets fired. But they get excluded. Reassigned. Invited to a coaching session about “tone.”

In time, everyone gets the message. The system doesn’t need to silence you. Your peers will do it for you.

We call it professionalism. But social psychologists might call it norm enforcement. The way groups maintain their identity by quietly punishing dissent. Or pluralistic ignorance. When everyone privately questions what’s happening, but no one says so because they believe everyone else agrees. Or the agentic state. That subtle shift where you stop seeing yourself as a moral actor, and start seeing yourself as just a cog in the machine.

It’s not that people don’t care. It’s that they’ve learned caring out loud is professionally risky.

When clinicians can’t safely name harm, patients don’t get safer. They just stop hearing the truth.

The cognitive dissonance doesn’t start when you witness harm. It starts when you learn to keep it to yourself.

And health care has become very good at managing this dissonance.

• Ethics consults are available — but typically after events, and only once the language has had a solid review approved by risk management.
• Incident reports are encouraged — unless the defect is structural, at which point the request is to “keep it internal.”
• Psychological-safety slide decks circulate — but voicing an inconvenient truth in morning rounds can still earn you a reputation for being “not a team player.”

We say we want transparency. What we want is plausible deniability.

New clinicians often believe their job is to advocate. To ask hard questions. To name what they see.

But advocacy has a price. Ask any whistleblower. Any nurse labeled “disruptive.” Any physician quietly removed from a committee for raising concerns about a patient death.

There’s a script for how to handle these people. It begins with wellness outreach. It ends with peer review. The exact language varies, but the story arc is always the same: The problem isn’t what they said. It’s how they said it.

Hospitals are not short on mission statements. What they’re short on is tolerance for moral clarity.

And so the culture adapts. We speak of harm in passive voice. We refer to preventable injuries as “unfortunate outcomes.” We coach new clinicians to be team players—which often means learning when not to speak.

We normalize silence by calling it respect. We reward detachment by calling it resilience.

The real tragedy isn’t just that people get hurt. It’s that clinicians learn to narrate those injuries in a way that keeps everyone safe—except the patient.

And when the harm is sanitized, the moral injury doesn’t go away. It metastasizes. Quietly. Systemically.

There is a reason so many clinicians describe burnout in terms of numbness. Because numbness is what you develop when you’re forced to feel everything, and say nothing.

So no, the first rule of being a doctor isn’t “do no harm.” It’s “don’t notice too much.” Or if you do, keep it to yourself.

If you want to last, that is.

After all, the most dangerous thing in a hospital isn’t a bad outcome. It’s someone willing to name one.

Jenny Shields is a licensed clinical psychologist and nationally certified health care ethics consultant specializing in clinician burnout, moral distress, ethical trauma, and complex psychological assessments. Based in The Woodlands, Texas, she leads a private practice—Shields Psychology & Consulting, PLLC, where she offers confidential counseling, consultation, and education for physicians, nurses, therapists, and health care leaders nationwide. Dr. Shields is committed to shifting the conversation in health care from individual resilience to system-level ethical reform. She is affiliated with Oklahoma State University and regularly contributes insights through public speaking and writing, including features on Medium. Her professional presence extends to platforms like LinkedIn, Google Scholar, ResearchGate, the APA Psychologist Locator, and the National Register of Health Service Psychologists.