Full Table of Contents
_______________
Abbreviated
Table of Contents
Home Page
Patient Safety
Silence vs
Safety
Silenced
White wall
of Silence
Silencing
Conflict Of
Interest
Psychology of
Providers
Subjectivity
Blacklisting
Nurse survey
Loyalty
Mobbing and
bullying
Trust Us
Defensive
documenting
Report Rate
Risk
managemnt
SOAP
Management
Hospitals
Crime in
medicine
Sexual Abuse
Liability
Limitations
Free Speech
for Patients
Exploitation
OSMB Medical
Boards
Mammography
solutions
Medical errors
Medical
Complaints
One number
Links
Injured patients who want to help and be heard, click here.
Thomas Jefferson said that given the choice between government without newspapers and newspapers without government, he would choose to have newspapers.
In medicine we have government without newspapers. Patients cannot find out what they need to know to make informed choices. No one in medicine records or reports the information patients need to know the most. So patients will have to.
Benjamin Rush
He still should be regarded
as
The Father of American Medicine
because he is why it the most dangerous place
we go
He was one of the founding fathers of the United States of America. His signature is on the Declaration of Independence, right above Benjamin Franklin's. He was the most prominent physician in the country. He was as prominent as George Washington and Thomas Jefferson and was called the “Father of American Medicine” and the “Father of American Psychiatry.” Since he was the first to advance the idea of free public schools, he also was called "The Father of Public Schools Under the Constitution.” And he was a pioneer in women’s education. What could there be to criticize?
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He is the reason that there still are no safeguards on quality and no market pressure on costs in medicine. A patient did epidemiological research on Rush's practice and determined that he did more harm than good. That could have been the beginning of patients being able to have access to the kind of information necessary to make informed, intelligent decisions about health care. But Rush put a stop to it.
Dr. Rush was supremely confident of his own opinions and decisions even though he was shallow and unscientific in practice. He thought nearly all ailments could be cured by bloodletting, and made a great deal of money with that and mercury purging, two practices that nearly every doctor at that time knew were bad for patients. The field had moved beyond that. Yet none of the learned doctors who knew better warned patients about Dr. Rush. Just as today no one in medicine warns patients about dangerous practitioners.
Thomas Jefferson visited a sick friend and wrote, ""When I visited him I saw that they were killing him by bleeding and mercury. . . " Jefferson could see it. Most patients cannot. Most patients believe doctors. Even George Washington let followers of Dr. Rush bleed him until he died.
During a fever outbreak Rush claimed to have healed 99 out of 100 patients.
If the patients of the world would pay attention to just this one fact. Today, just like 200 years ago, caregivers always find ways to believe unfounded, uncounted, untabulated and fanciful success rates for themselves. They still evaluate their own practices in exactly the way that Rush did. No one else checks the success rate of caregivers. Caregivers have an extremely strong need to believe that they are good. That overwhelms their thinking as they create the records to show that they are perfect, or nearly so, like Rush did, with no legitimate basis for such imaginings. In their hearts they believe it. When studies find that only 2% of adverse events are accurately reported, they don't believe the studies, because their perception is that they and the caregivers they know have nearly perfect records.
Of course they don't, but they never will see that. So we need a third party to bring a lucid perspective. Laws and regulations and education cannot make caregivers become unmoved by self interest and see the world honestly. They aren't saints. So we need people in positions that do not require sainthood in order to have an honest, objective perspective, like William Cobbett.
Politics and prestige instead of safety still rules
An English pamphleteer named William Cobbett, in "Peter Porcupine's Gazette," constructed tables, from publicly available data, that elucidated the increase in mortality in September after the “Pennsylvanian Hippocrates,” as he called Rush, practiced bloodletting there. Other critics backed up his findings with similar tables.
That could have been the beginning of the field of patient safety, if Rush had not begun the tradition that prevents people to this day from understanding, judging and analyzing their health care. Rush sued Cobbett into silence.
Rush had announced that his practice had conquered the epidemic. Cobbett asked Rush to produce a list of patients he had healed. Rush said he had not had time to make a list. Cobbett knew that three of Rush's apprentices had died from the fever and that Rush's own daughter had died from it. So Cobbett quipped, in print, that even though most of Rush's apprentices had died from it, surely enough had survived to make a list. So Rush silenced him with a lawsuit, just like they do today.
When this story is told to physicians today they defend Dr. Rush saying that a practice cannot be judged in this way because it could have been that Dr. Rush happened to get a lot of patients who were unusually sick. Do they think that mercury heals people? Do they think that drawing blood helps? Even in the face of that do they deny the statistics that revealed that Rush was doing more harm than good with such practices, like they deny the statistics today that reveal such unacceptable truths about had dangerous medicine is?
Today everyone knows who Jefferson and Washington were, but no one remembers Dr. Rush. It became clear that Cobbett was right. So it was covered up - like bad things in medicine are covered up today. And still no one who is objective collects honest information so that the community can know better than to seek care from the incompetent or even just plane evil. Nothing has changed in 200 years.
Through the power and prestige of his position
he got patients
to pay him to make them worse
and then got richer
by suing someone for complaining about it
While Dr. Rush was at the Constitutional Convention helping to write that document, he tried to get language written into it that would guarantee the freedom to practice medicine in whatever way a practitioner desired just as there was language guaranteeing the freedom to speak. He said, "Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship to restrict the art of healing to one class of man, and deny equal privileges to others. The Constitution of this Republic should make a special privilege for medical freedom as well as religious freedom." He tried to make it illegal for the members of his profession to band together to restrict practices they thought to be harmful, like his practices.
He did not manage to do that, but with his lawsuit against Rush he did manage to make it so no one ever again would monitor the outcomes of physicians. The solution to patient safety problems was in our hands and it was stopped by a physician who did not want patients to be able to evaluate caregivers. To this day no one has managed to do again what Cobbett and others did back then - identify for themselves the cause of so much unnecessary death and suffering in medicine so that other patients could avoid it.
The Father of Patient Safety?
The medical community did not try to warn patients about the antiquated practices of Rush, so a citizen did. Cobbett might have become known as the Father of Patient Safety if medicine was not so good at silencing its patients and critics.
During the yellow fever outbreak in 1793, in which thousands of people died and many others fled the city to escape it, Cobbett claimed that Dr. Rush was bleeding people not because of any scientific findings that supported the practice, but because Rush wanted to be at the helm of something great.
Rush sued Cobbett and defeated him. It's not as though Cobbett did not have adequate legal representation. Alexander Hamilton himself tried to protect Cobbett from legal measures. But a jury awarded damages to Rush that so ruined Cobbett that he had to flee to England after paying a settlement to Rush.
With all of the criticism of public figures, like politicians, that appeared in Cobbett's famous gazette, it was a physician with a lawsuit who managed to silence the voice trying to protect the people. It is no different today. One of the first things patients usually hear after an adverse event is the rattling of the sabers of risk management making it known that defamation suits can be brought against anyone who talks about it. No matter which side sues, and no matter who wins, a gag order will result. The last thing medicine will let happen is for negative information to get out.
Dr. Rush never managed to convince his friend, Thomas Jefferson, that doctors do less harm than good, but Rush did succeed in stopping we the people from having the means to protect ourselves from people like him. He stopped us even from talking about the harm that he himself was doing. To cover up the truth, Dr. Benjamin Rush's own correspondence was hidden for about 200 years.
Public Health
Sixty years after Rush, John Snow, in England, compiled maps and tables similar to the ones created by William Cobbett, but instead of showing the results of the practice of a physician, his showed that people getting water from one water company were dying of cholera while people getting water from a different water company were not dying. This act began the field called "Public Health" and John Snow now is known as the father of epidemiology. If not for Rush, Cobbett could have been the Father of Patient Safety today. Today whole institutions are devoted to gathering statistics that show what is good and what is bad for public health in the same way that John Snow did. But not in the way Cobbett did.
Snow could do that because he was not criticizing doctors. He was criticizing water companies. So no one sued him. If he had criticized the practice of a doctor or a hospital in the same way, even today he would be sued into silence. Patients still cannot learn the success/failure rate of doctors or nurses or hospitals. They still cannot warn other patients about what they have learned from their own experience. And there still is no one monitoring health care they way they monitor public water supplies and commercial kitchens and the like.
How much safer would we be if the work of William Cobbett had made him the Father Patient Safety, a field that constructs tables of patient outcomes to show the success rate of various doctors, various treatments and various hospitals? Patients think someone is doing that already. Patients think that someone is making sure that incompetent operators do not have long careers injuring patients. They are wrong.
Patients still cannot complain to each other about doctors and nurses. Doctors and nurses can complain to each other about patients in ways that prevent patients not only getting their injuries in the record, but that even prevent them from getting treatment for those injuries, which can result in worse injuries or even death. Doctors literally telephone each other and warn each other not to diagnose a patient when that diagnosis could be used as evidence against a colleague who has injured the patient, even when the injuries were incurred through abuse (actually, "especially" when those injuries were caused through abuse). And patients cannot sue them for doing that. And patients cannot warn each other about it. If they do they can get sued like William Cobbett.
Patients who have been injured find there isn't even anyone to complain to. When they try to find someone to complain to, they find that the only organizations that exist are ones that represent caregivers. There are none representing patients. The stories of Dr. James Burt and Dr. Vikas Kashyap are not "one-offs." They are the way it works for patients.
This was something else about which Cobbett complained. He criticized the composition of the Philadelphia board of health on the ground that doctors composed nearly half of its members., Sadly, that situation is even worse today. The boards that are supposed to regulate that profession are run almost entirely by doctors. So there was no one in an official position protecting patients when Rush used Mercury as a medicine, just as there is no one today watching to make sure that physicians like Arthur Schramm do not spend decades practicing with no one but patients knowing why they should not be allowed to. (State medical boards curb the members of their professions only when put in a position in which they have no other choice. They do not go out looking for problems).
Cobbett complained that Dr. Rush's care might have been what killed George Washington. How could journalists, or anyone else, search for and share information to get to the bottom of that, or anything else that might protect patients from someone like Rush, when physicians could sue them for doing so? It didn't matter that they were telling the truth and had documents and witnesses. Just defending such a suit can be ruinously expensive, and losing it is devastating. Rush was using mercury as a medicine. And managed to persuade a jury that he was the injured party. It is no different today when doctors and nurses injure patients.
So Cobbett did not get named The Father of Patient Safety, because birth was not given to the child. We tend to think that when the time is right advances will be made. If John Snow did not give birth to epidemiology, surely someone else would soon thereafter, right? But in the more than 200 years since no one else has given birth to the field of patient safety. Snow birthed public health, but the field of patient safety to which Cobbett was trying to give birth was aborted at its inception.
Without John Snow it easily could be that there still would be no Centers for Disease Control (CDC) or National Institute of Safety and Health (NIOSH). Without him there might not be institutes of higher education offering degrees in epidemiology and public health. Just as, more than 200 years later, there still are no institutions offering degrees in patient safety that train people to collect data to identify problem practitioners and problem treatments and such like. If a radiologist is incapable of recognizing the early signs of breast cancer in an X-ray, no one ever will know. The government tried to protect patients from that specific thing, inept radiologists, but medicine prevented it through lobbying.
Patients think that someone is watching out for them. They think that someone out there must be looking for warning signs and listening to complaints. The people who appear to be doing that are people who share the perspective and interests of healthcare providers, not people who share the interests of patients. That's why cases like Dr.Arthur Richard Schramm fester for decades.
The only people who will report these things are patients, but they get sued. Consumer Reports cannot analyze medicine the way it analyzes hair dryers because the information is not collected and efforts to collect it are stopped. Health care providers have a vested interest. They do not want to be analyzed and they do not want the data collected. 98% of adverse events are not reported by people in medicine (see Medical Reporting). It is not in their interest to know it, so they don't. Patients can report an important amount of that information, but no one gathers it from them. When patients try to get their own information used to protect other patients, they get sued.
Patients need to be able to speak without getting sued. And they need an organization that shares their perspective when things go wrong. They need for William Cobbett to be able to tell them about Benjamin Rush. They need victims of adverse events in medicine to be able to get their stories heard so that all patients can learn from them. But instead the system still protects Benjamin Rush over patients. And the issue is not just safety. It also is the cost of medicine. Without this kind of information, there is no way for patients to be intelligent consumers, comparing costs versus outcomes, and thereby creating a market that drives up quality while driving down costs.
If we do not do something about that now, it easily could be another 200 years before anyone tries again. But I fear that we are too mired in our own group-think that imagines that we can educate and/or regulate caregivers into becoming saints who will take care of all that for us (see The Saint Theory of Medicine). We probably will continue discussing that fantasy for another 200 years with no improvement in the unacceptable rates of death and injury in medicine.