The Cost of Being Right

A friend, Arya, shared an experience from a patient care conference that took an uneasy turn.

Six colleagues sat around the table discussing a 78-year old who was managing with limited reserves. Among the recommendations moving forward was to schedule a surveillance colonoscopy. The patient’s history included a clean scope but that was ten years ago.

Arya was the patient’s geriatrician.  Having read the whole chart, she spoke up.

A study of nearly 92,000 veterans found that, for someone in this patient's situation, the ten-year risk of dying from colorectal cancer was less than one percent. The risk of dying from everything else was closer to fifty. The procedure itself carried genuine risk for someone this frail: anesthesia complications, GI bleeds, a recovery that could cost her more than the cancer risk it was meant to address. Arya said she thought it was worth discussing.

The gastroenterologist looked up from her notes.

"I've been doing this for fifteen years," she said. Not unkindly, but with a finality that closed the door. "Standard of care exists for a reason."

Arya nodded, then tried once more.

She wasn't arguing against colonoscopies, she said. She was asking whether this patient, specifically, given her frailty and her history, was the right candidate for this procedure right now. The study was recent, peer-reviewed, published in JAMA.

The conversation had gone a degree or two cooler.

"I think we all want what's best for the patient," the gastroenterologist said. And the way she said it suggested the discussion was over.

Someone introduced the next agenda item.

The Arithmetic

Driving home afterward, Arya ran the familiar truth-teller's litany.

First came the self-questioning. Had she misread the evidence? Had her tone been wrong? Was there a better opening she'd missed? She knew, rationally, that her concern was sound. But the meeting's reaction had done what groups do: it had turned her certainty into a question she couldn't stop asking.

Then came the longer reckoning. She thought about how she'd be read in that setting going forward: as someone who'd made things difficult, not as someone who'd raised a legitimate clinical concern. When that repositioning happens, it tends to hold. The next time Arya raised a concern, would people discount it before she finished the sentence?

And then, pulling into her driveway, she noticed something that troubled her most: she was already calculating whether next time would be worth it.

That calculation is the real cost: the internal adjustment, the raised threshold for speaking, the weight of what it might cost her professionally to be seen as someone who pushes back.

Organizations exert a powerful gravitational pull toward conformity. The rewards flow more easily to those who move with the current. Most people learn and adapt to this early.

But we need to stay conscious to how we’re adapting. Someone who compromises without awareness gradually loses track of what they've given up and why. They find themselves, years later, having drifted so far from their own judgment that they can no longer hear it clearly.

The more honest path is harder: stay aware of what you're trading and what you're getting in return. Know where your limit is, the point at which further compromise costs you something you cannot recover, something essential to who you are and what you're there to do. And when you reach that limit, act on it. Sometimes that means a direct confrontation. Sometimes it means finding a setting where your voice can actually matter.

Arya hadn't reached that limit yet. But she knew she was closer to it than she'd been before.

She’d been right. And the system had proceeded without her anyway. That particular combination, accurate and overridden, is one of the most demoralizing experiences professional life produces. And it's the one most likely to ensure that the next truth goes unspoken in that environment, by that person, until she decides the cost of staying has become higher than the cost of leaving.

It isn’t being wrong that teaches us to stay quiet. It’s being right and ignored.

None of this means the answer is to go quiet. The discomfort Arya felt in her driveway is itself evidence that her judgment was still awake, still hers. The people who've actually stopped mattering in rooms like that one are the ones who no longer notice the cost at all. Arya noticed and, uncomfortable as that was, it’s what kept the door open for “next time.”

I've watched this pattern resolve in positive directions at times. One colleague who kept speaking carefully, for months, until one day someone else spoke first. Another who spoke up until the group came around to his way of thinking. It doesn't happen every time. But it happens more often than the driveway moment leaves us feeling.

Dissent is not disloyalty, even though it often gets read that way. Disloyalty turns away from what you've committed to. Dissent stays in the room and risks the relationship precisely because the relationship still feels worth the risk. Indifference is silent. Dissent is not.

What made Arya's afternoon so heavy wasn't the disagreement itself. It was the subtle arithmetic that had already started before she'd reached her car: how this would be remembered, what it might cost her the next time she needed to be heard, whether she'd already spent something she couldn't easily get back.

Practice Invitation

Think of a moment when you knew something in a professional setting that you didn't say. A concern you set aside because the momentum was moving elsewhere. A question you swallowed because the temperature made it feel too costly.

Ask yourself: what was I protecting when I went silent? My standing? My access to resources? My sense of belonging to something I didn't want to risk?

Then ask: what did the group lose when I didn't speak? What did I lose?

And finally, the harder question: how conscious am I of what I'm trading in order to belong here? And do I know where my limit is?

Simply noticing this is the place to start.

And that’s The Gist of It™.

Thank you for reading. If this resonated with you, I’d be honored if you’d forward it to someone who might appreciate it. Subscribe below to receive these weekly:​

Marilyn Gist