If It’s Not Right, Don’t Do It
What Marcus Aurelius Knew About Success That Most Entrepreneurs Ignore
You know that moment when doing the right thing is going to cost you? Yeah, that’s when it really matters.
I remember getting a phone call. A daughter wanted more home health care for her mom—a patient we’d helped get better. The problem? Her mom didn’t qualify for Medicare coverage anymore because she was already better. When I explained this and mentioned she could pay out of pocket if she wanted to continue, she got angry and hung up.
Next thing I know, we’ve got our first negative Google review. She wrote that we were “only interested in money,” and that’s why we wouldn’t take her mom on.
I still remember staring at that one-star review, feeling the punch in the gut. Here’s the irony: if we were actually only motivated by money, we would have taken her mom as a patient.
And for a second, I wondered—Did I handle that the right way? Should I have figured something out?
I knew the answer. Sure, if I had been willing to stretch the truth a little (or a lot), I probably could have found a way to document things in a way that satisfied Medicare. Some people do. It wouldn’t have been obvious.
But it would have changed something.
Not just a line on a form, but how I saw myself and how my team saw me. How my team saw us. If I compromised once, it would have been easier the next time. And the next.
So we didn’t take her.
Marcus Aurelius wrote, “If it is not right, do not do it; if it is not true, do not say it.”
It’s easy to agree with that in theory. It’s a lot harder when you’re staring at your first negative review, wondering if people will believe what’s written there.
The Daily Cost of Doing Right
Over the twenty years I owned my home health agency, Medicare and state regulations got more and more complex. The path to maximum profit became pretty clear: provide the minimum amount of care to each patient that you could justify.
That’s not what we did.
We believed Medicare’s intent was for agencies to make a profit in aggregate—some patients you’d make money on, some you’d lose money on, some you’d break even. This way, you could provide the right amount of care to each patient, not just the minimum.
Almost every big agency in our area was trying to maximize profit from each patient. Many of them grew faster than we did. Some got acquired for big money. Meanwhile, we were growing, but slowly, and no one was banging down my door with offers to buy us out.
And I’ll be honest—sometimes I looked at those fast-growing agencies and thought, Are we the idiots here?
But I also knew we were building something different: doing the right thing and building a reputation for doing what was right. Our referral sources knew we wouldn’t cut corners. Our staff knew they could make decisions based on patient needs, not just profit margins. It might have meant slower growth, but it built something that lasted.
When “Everyone Else Is Doing It” Isn’t Enough
“Other agencies are willing to do it.”
That’s what the doctor told us when we refused to pay him $500 for each home health patient he oversaw. He acted like we were the weird ones for not playing along. Like it was just a game.
And honestly? He had a point.
Other agencies were willing to pay him. They could cut costs in other ways (like reducing care) to make up for it. For a while, it probably looked like they were the smart ones.
Until they weren’t.
That doctor eventually lost his medical license and went to prison for Medicare fraud. At least one of the agencies that worked with him faced massive fines. Another one just shut down quietly.
That’s the challenge with integrity: sometimes you look like the foolish one until time proves you right.
Culture Is Sometimes What You Won’t Tolerate
Sometimes integrity shows up in unexpected places. Like dirty laundry.
I had an RN who was new to our team. One day, I went to see a patient she’d visited earlier. The patient, who had very limited mobility, told me he’d had an accident and asked if I could help clean up. He mentioned he’d asked the RN, but she told him she “didn’t do that kind of thing.”
Technically, she was right. It wasn’t in her job description.
But that’s not how we operated.
I sat with it for a day or so before talking to her. I wanted to understand where she was coming from. Maybe she didn’t realize how big of a deal this was to the patient. Maybe there was something I wasn’t seeing.
But when I brought it up, she didn’t budge. “I didn’t go to school to become an RN so I could clean up dirty clothes,” she told me. She suggested we should send out a home health aide for things like that.
And that’s when I knew this wasn’t going to work.
When I told her we’d be letting her go, she was shocked. “I’m an RN. I can get a job anywhere,” she told me.
I nodded. “I know. But this isn’t the place for you.”
It wasn’t personal. She just wasn’t a fit for the culture we had built.
What surprised me was how much that decision meant to the rest of the team. Several nurses came to tell me how it reinforced what we stood for. One told me, “I’ve cleaned up worse messes than that, and I’d do it again. That’s what caring for people means.”
Every decision about integrity is also a message to your team about what matters most.
Making the Right Choice When It’s Not Clear
Not every ethical decision comes with bright lines. I remember sitting in my office, staring at a contract that could have meant major growth for our agency. The terms weren’t clearly wrong, but something felt off. The pressure to decide quickly was intense—the opportunity wouldn’t wait.
In my experience, the hardest choices aren’t between right and wrong. They’re between right and almost right.
Over time, I developed a way to navigate these gray areas:
- Start with your non-negotiables. What values define who you are? What would you rather lose money than do?
- Be skeptical of urgency. When someone is pushing for an immediate decision, that’s usually a red flag.
- Think about your future self. How will you feel about this choice in a year?
The best choices come when you have space to think them through. And when you create a company culture where it’s safe for your team to raise concerns, you make it easier for everyone to do the right thing.
The Truth About Doing Right
Looking back, those negative reviews and lost patients don’t bother me. What would have kept me up at night was knowing we took shortcuts with people’s care.
That RN probably did find another job easily. But our team got stronger when she left.
That doctor who wanted kickbacks? He probably made a lot of money before he got caught. But we kept our freedom and our integrity.
I won’t pretend it’s easy. There were times I wondered if I was just being stubborn, if I was making things harder on myself than they needed to be. But looking back, the things I lost don’t bother me. The things I could have lost, though—my reputation, my values, my peace of mind—those are what really mattered.
At the end of the day, you have to live with yourself. And that’s a decision no one else can make for you.
