At one time I proposed patients joining together to form a group to attempt
to effect changes that I now believe can be accomplished only by an official
institution of some kind that advocates for patients, as is mentioned on the
homepage of this side, but even though I have moved on
from advocating this, I leave this page here for some of the thoughts on it.
The desensitized personal consciences of doctors
are supposed to be replaced by "institutional consciences."
Doctors cope by manufacturing a professional distance between
themselves and the disasters they face. To become a good doctor requires a
certain amount of depersonalization, coming to regard people as objects rather
than humans. But turning off passion is not just a coping mechanism, it also is
a rule governing how they are supposed to behave.
A doctor is supposed to treat the patient in front of him or
herself, period. Inclination and moral judgment are not supposed to interfere
with their work. Whether it is dissecting a disgusting cadaver in medical school or
treating the apprehended pedophile for AIDs, they are trained and hardened to be
amoral pragmatists. If you were looking for the worst way to produce
moral leaders, medical training might be it.* And yet who is in charge of the
medical boards that are supposed to bring conscience to healthcare? Doctors.
To police this constituency, we appoint members of the same
constituency. Appointing hospital administrators is unlikely to be more
practical. They already manage organizations that do not find or report
problems. Perhaps a few injured patients should be appointed.
Without clear definitions of the limits of their authority
and options,
doctors are dangerous.
The laws governing jury trials do not mandate that juries be
composed of doctors even if the crime is medical. We look to juries composed of
regular citizens to make grand, life-altering, precedent-establishing decisions
about right and wrong. In the end a state medical board is the judge and jury.
Why are their boards composed almost entirely of doctors?
People who have hardened their consciences in order to carry
out specialized tasks are the wrong people for making moral decisions no matter
how eloquent and authoritative they appear and believe themselves to be.
Certainly a state medical board would want doctors and nurses available to
explain issues, but to have them also be judge and jury is folly. Institutions
governed by doctors are too sympathetic to doctors and too desensitized
to patients.
The OSMB fails to provide the institutional conscience
necessary to protect patients.
Beyond the issues of sympathy and desensitization is the
issue of managing a bureaucracy. MDs are not MBAs. Below the board of directors
of a state medical board is an organization that needs to be directed. People in
business get advanced degrees in management and spend years on the job learning
to be managers. That's not what doctors do.
The theory might be that there are career civil servants
employed to handle management, but the unique nature of the privacy laws hiding
what they are doing renders them civil servants who are accountable to no one.
If there are any questions about how bad an idea that is, compare their disciplinary actions to the
complaints they receive. The board of directors serves more as judge and jury
than as overseers of a bureaucracy. The bureaucracy is left alone behind closed doors. No
matter how well meaning they might be, that is a bad idea.
The laws governing the composition of state medical boards,
and the great influence of medicine, leave little hope for meaningful
improvement in the current way of doing things. They can pass new rules and reorganize all they want. They've done that in the past without producing results that are any different. It still will be an organization that lobbies the state government to pass laws against patients, rather than an organization the really is on the side of
patients.
Below I suggest forming a citizen's watch dog group to monitor it, but I am not sure how much good that actually will do. It might be worth exploring, and so I contribute some thoughts about it here, but what is needed first is simply a phone number, one single phone number that can be called with all
complaints about healthcare, and that I've written more about at this link. There needs to be someone at that number who can tell patients how to get a hospital to cough up documents, and what to say to the police when they say to call the state medical board, and myriad other things no one currently tells
injured patients.
Thoughts toward the creation
of a citizen's group
The public will not use a system that is not believed to be responsive or fair. Many come to the conclusion that the state medical board is not responsive or fair before they even receive the complaint form in the mail. Just on the basis of interacting with the state medical board on the phone, they already are
discouraged enough to resign themselves
to suffering negligence and abuse with no hope for protection or justice. I have brought this up with the state medical board and suggested monitoring the phones to find out how many people telephone, but then give up without going any further. They were not interested in finding that out.
This is one of the many
things that would have to be discovered by an outside group. If nothing else, or perhaps as a first step, a Citizen's
Group could propose studies that need to be done and then look for funding for
those studies. Other organizations and universities could do them. Studies should be about everything from finding what percentage of people
know that a medical board exists, to tracking cases to find what kinds of sins never
are punished and why, to monitoring their phones to learn how to improve the means of access
for the help-seeking public.
However, I have come to the conclusion that what we most probably would learn in the end is that the real business of protecting patients unlikely ever to be able to be conducted by a licensing agency. It will have to come from somewhere else with the state medical board merely responding
by revoking licenses from time to time, which is the way it already operates.
Below are some thoughts I had a few years ago when I was suggesting things for discussion about how a citizen's oversight group might be used to help state medical boards protect patients. But as time goes on, the idea of "state
medical board reform" seems naive. Their inertia always will be wrong for the job that needs to be done to protect patients. Currently they almost never discipline anyone unless some other agency finds the person guilty first. We perhaps would be better served to create an agency that either does investigations or at least makes sure that
already existing agencies do not defer their investigations to state medical boards. Especially the police.
* * *
The Ohio State Medical Board needs to become more
consumer-friendly
even if a referendum creating a Citizen Oversight Group
is required to bring
that about.
After that the first thing needed is auditing to investigate
the process by which the Board accepts and investigates complaints about
medicine. The thoroughness and fairness of the process needs to be scrutinized
and revealed to the Board if to no one else. Although it really should be made
known to the public as well.
Since the talent, fairness, dedication, and flexibility of
the participants in the process are more important than the system's processes,
in the end someone outside of the Board will need the authority to direct or
remove individuals who do not meet standards. From what we've been able to see
so far it appears that some operators in this system are checking boxes on forms
without making an honest effort to accomplish anything. If the Group, or an
independent third party like the Citizen's Group, cannot either direct or remove
such people, its effectiveness will be diminished.
The second thing needed is for someone like an oversight
group to commandeer select cases, recruit outside investigatory help and come
face to face with the same obstacles faced by the Board in order to gain
perspective and learn lessons.
The third thing needed is the setting up of an appeals
process by which the Citizen's Group or someone like it will review cases
brought to it by patients who feel they were not dealt with justly by the Board.
As far as we can tell (someone please let me know if I'm wrong) the Board
handles such cases by running them through the same process they went through
the first time.
Either there will be multiple institutions having authority
or there will be tyranny
One can anticipate many of the objections of the Board and
Medicine itself to the idea of citizens studying and perhaps even overseeing
this. Among the objections may be the notion that only doctors can understand
medicine and only police can understand policing. But you don't have to have an
M.D. to know when you're being raped. You don't have to have graduated from the
police academy to know that failing to learn the identities of the nurses who
witnessed a crime is not an adequate investigation. You don't have to have been raped
to see that the Board never finds anyone guilty of things that, like rape, do
not generate paperwork.
The Board is in dire need of auditing and oversight by people
with a perspective different than that of the police and the physicians.
For more information about why oversight is needed, click
OSMB
or consider the general history of all policing entities
operating behind closed
doors
*Part of the definition of psychopath is an inability to feel
normal emotions relating to the damage one does. To a certain degree it could be said
that medical schools manufacture people like that. Of course, the detachment is necessary if
they are to be able to do their work, but why is everyone surprised when some of
them behave like psychopaths? And why do we not have structures erected to
respond when they do?
Traits normally associated with psychopaths include being manipulative and grandiose, exhibiting a lack of empathy, refusing to accept responsibility for one's own actions, an inability to feel remorse, and relating to others on a superficial level. Aren't all of those on the checklist of the
surgical personality?
If you want to say something about any of my
sites, my phone number is on almost every page. So is my
email address. There even
are Feedback Forms where you can communicate
anonymously. I am listening. I will be sensitive to what you say.