How Often Do We Pull Strings?

How many times have we accelerated something by using our connections? Instead of days, a scan was approved in a matter of hours. A call that puts a loved one on the waiting list. A coworker who discreetly "looks" before a meeting is scheduled. Although these incidents are rarely dramatic, they highlight a basic truth about medicine: those who understand the system can work within it, while those who don't have to endure it.

The majority of physicians do not consider it to be a misuse of privilege. We believe it shields the people we love from a system we no longer completely trust. Too many patients have fallen through the cracks, too many delays have occurred, and too many mistakes have been prevented. Neutrality feels like neglect when it comes to our own family. We therefore take action because we are unable to bear the risks we are too familiar with, not because we wish to gain an advantage.

That ability to "move the system" comes with a hidden price. Each favor granted only deepens the divide - separating those who have access from those who don’t. It might not be corruption in the usual sense, but it still undermines fairness. The more we depend on personal connections to make care feel human, the more we reinforce the idea that true humanity isn't woven into the system itself.

There's no ill intent behind it. Most of us operate on instinct rather than arrogance. We've all witnessed how minor delays can spiral into major crises. We've seen good people struggle because a system is too slow, too congested, or too oblivious. So when it hits close to home, we take action. And perhaps that's what complicates things - it stems from love, not entitlement. Yet, every time we step in, we’re reminded that so much of medicine hinges on connections, not just on what you actually need. It's not documented anywhere, but it's very real - an unseen web of favors and understanding that keeps everything flowing. It works like a charm when you're part of it, and painfully when you're left out.