As residents and medical students progress through their medical training, they are presented with multiple instances in which they feel they must manipulate the healthcare system and deceive others in order to efficiently treat their patients. This, however, creates a culture of manipulation resulting in untoward effects on trainees' ethical and professional development. Yet manipulation need not be a skill necessary to practice medicine, and steps should be taken by both individuals and institutions to combat the view that the way medicine must be practiced "in the real world" is somehow different from what one's affective moral sense implores.