Rep. John Lewis nearly lost his life on the Edmund Pettus Bridge in Selma, marching for rights that should never have required a march. His courage redefined the moral calculus of resistance, what he called “good trouble, necessary trouble.”
I’ve created trouble too. Not on bridges, but in boardrooms. Not with batons overhead, but with data, dissent, and quiet refusal. I’ve challenged supervisors, disrupted systems, and questioned protocols that harmed more than they healed. I was never bodily harmed, but I was often institutionally inconvenient.
Good trouble isn’t measured by bruises. It’s measured by the discomfort it causes in stagnant systems, the clarity it brings to silenced truths, and the legacy it leaves behind.
At one clinic, I noticed the DD-600 (the official medical record) lacked developmental milestones. No Denver Developmental Screening Test (DDST) sheets. No reference to the “Key Denver items” that were standard in every Yale outpatient record. I flagged this to a supervisor. His response: “We don’t have DDST forms.”
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I replied, “I have the latest edition of the Harriet Lane Handbook. It includes a fold-out DDST section.” What I didn’t know then was that Pasquale Accardo, my future mentor and boss, had helped shape that very section.
My supervisor gave me permission to revise the DD-600, but only on off-duty hours. That caveat said everything. The system didn’t oppose reform outright; it just refused to fund it, endorse it, or acknowledge its necessity. But I did the work anyway. Quietly. Precisely. And the form changed.
When I arrived in Minot as an Air Force officer and pediatrician, I didn’t wait for a referral or a directive. I walked down University Avenue and introduced myself to the leaders of Minot State University’s early childhood education and speech-language programs. My question was simple: “How can I help?”
They were surprised. But that question marked the beginning of a four-year renaissance, one that bridged military pediatrics, early childhood education, and speech-language therapy. We built systems of shared knowledge, better referrals, and collaborative care that benefited countless children and families.
With support from an Army developmental-behavioral pediatrics (DBP) consultant, I created the first “medical home” for pediatrics within the Department of Defense, two years before the American Academy of Pediatrics (AAP) formally defined it. From that effort emerged an interdisciplinary developmental clinic, integrating comprehensive care for children with diverse needs.
Good trouble doesn’t always begin with confrontation. Sometimes it begins with a walk, a question, and a refusal to wait for permission.
During a winter blizzard in Minot, I was the medical officer on duty (MOD) in the emergency room. When my shift ended at 1630, chaos escalated. My relief, a family practitioner (FP) I had nearly failed in residency, refused to cross the snow gate from downtown. The second backup MOD, the chief flight surgeon, refused to leave his base housing less than a mile away. Tempers flared as the deputy commander, the FP, and the flight surgeon argued over speakerphone, proposing absurd solutions like deploying a six-wheel armored vehicle to retrieve the FP, neglecting that it could also fetch the flight surgeon.
I was the sole voice of reason. As the medical officer on duty, I was the voice of the hospital commander: I volunteered to stay for another shift. The ER promised quiet, and I asked only for a $5 meal allowance. The squabbling trio agreed. The dentist and his aide departed swiftly.
I documented everything in a memorandum for the record, co-signed by ER techs. At 11:30 p.m., the hospital commander, Col. Dodd, and the chief of hospital services arrived, having evaded the snow gates and driven through wind-swept highways. “What in the hell are you still doing here?” he asked. I handed him the memo. His face turned red, the only time I saw his emotions. “Keep up the good work and get some sleep,” he said. Monday would be more eventful for him.
In Phoenix, the push for productivity reached its breaking point. I was already seeing more patients than my colleagues, generating higher revenue without pediatric nurse practitioners. But the health system’s model was clear: productivity above all. Quality of care was collateral damage.
I upheld my principles: evidence-based care, equity, and dignity for all. My outreach to the Hispanic community built trust, but drew resentment. Colleagues saw my commitment to justice as disruptive. My attitude (“Lead, follow, or get the hell out of my way”) only fueled their resolve to silence me.
Still, I pressed on. My convictions aligned with Christ’s teachings: “Let the little children come to me” (Matthew 19:14, Mark 10:14, Luke 18:16). Christ welcomed children not for their status, but for their trust and openness. That was my vow.
Then came the purge. The chairman of pediatrics handed me my notice. HR dangled three months of medical coverage as a condition of silence. The new chairman of pediatrics (an ethicist, bitter irony) delivered the verdict: shift focus away from Hispanic children on Medicaid. Prioritize paying patients.
It wasn’t a suggestion. It was an order. “Your care of the Hispanic population is hurting our economic bottom line.”
That sentence unraveled everything. Medicine reduced to margins. Care abandoned for profit. It wasn’t just policy; it was institutional cruelty. I was purged for my Christian beliefs of equity.
In Peoria, Illinois, Medicaid went bankrupt in early 2013, sending shockwaves through the health care system. A vice president of a children’s services nonprofit summoned me with what she believed was a viable solution.
It wasn’t a solution. In my view, it was a federal crime.
Her directive: alter the evaluation process for children on Medicaid and exclude speech therapy and occupational therapy. Why? To save the agency money.
I told her, without hesitation, that what she was demanding was illegal. Her proposal violated the principle of medical necessity and constituted discriminatory practice under CMS guidelines, particularly the exclusion statute (42 U.S.C. § 1320a-7).
She heard me. And yet, she persisted.
Despite knowing the legal risks, she ordered me to execute the plan. She wasn’t my employer (my salary came from the University of Illinois College of Medicine at Peoria, or UICOMP), but she wielded financial blackmail with precision: “If you do not comply, [the agency] will terminate its financial support for your UICOMP salary.”
The ultimatum was clear: Obey illegal orders or lose my job. Profit over ethics. Profit over legality. Profit over children.
I didn’t hesitate. I laid out the details of the order, first by phone, then in writing, to Dr. de Alarcon, chairman of pediatrics. The whistleblower protection wasn’t just a legal shield; it was a moral necessity.
Good trouble lives in these moments, not just in marches or manifestos, but in memos, refusals, and quiet acts of defiance. I didn’t seek conflict. I sought care. But when systems demanded silence, I chose testimony. John Lewis crossed a bridge. I crossed snow gates, clinic thresholds, and institutional fault lines. The terrain was different. The vow was the same. The trouble was good. The children benefited.
Ronald L. Lindsay is a retired developmental-behavioral pediatrician whose career spanned military medicine, academic leadership, and national advocacy for dignity-centered neurodevelopmental care. His NIH-funded work with the RUPP Autism Network helped define evidence-based approaches to autism and related developmental disorders.
He directed the LEND Program at The Ohio State University and founded JBLM CARES, a $10 million autism resource center for military families. His writing spans clinical scholarship and long-form fiction. He is the author of The Mercy Directive and the six-novel Cassandra series, a completed political and medical fiction saga tracing the rise of the Cassandra system from its origins to its national and international legacy. His forthcoming memoir, The Quiet Architect, examines how conscience and structure collide in modern medicine.
He shares updates on LinkedIn.
