Crime in Medicine
I have to rewrite many portions of this site, but
especially this one. I have not yet managed to make clear why crime is the
fundamental problem in healthcare. When our systems fail to acknowledge the
problem of intentional harm, let alone do anything about it, they are not
systems adequate to policing less sinister problems.
When you mention the crime rate in medicine, healthcare
professionals
brush it off as being rare. Would we accept it from the police if they brushed
off
rape on the street because that is so rare? Or any other crime outside of
medicine?
The Routine Activity Theory of crime is one that should be discussable with regard to crimes committed against patients since it emphasizes situational factors which give rise to criminal opportunity rather than blaming individuals. That fits in with the current vogue in patient safety discussions which is to blame the
institution or environment rather than the people who commit the crimes. (All the way back to Thomas Hobbes it has been recognized that no matter how pure or "good" someone was, he or she still could be a violent, selfish human being. But currently, in spite of all testimony and statistics to verify that is the case even for surgeons and
nurses, that is something that is treated as though it were not even worthy of discussion [for instance: "we don't believe people go to work to to a bad job"], so lets just deal with Routine Activity Theory of Crime).
Any patient safety effort that does not begin
by addressing the problem of crime against patients
ignores the fundamental problems
Routine Activity Theory says that crimes occur when three conditions are present:
1) a suitable target is available
2) there is no guardian to prevent the crime
3) a likely and motivated offender is present
1) Patients are easy targets. They are trusting and nearly helpless, like children, and have almost no ability to respond to crimes committed against them. They don't know how to respond or who to turn to to find out. There is no number to call to get an advocate. If you think the victim can get help by calling a
lawyer, first read elsewhere on this site about how unlikely it is for victims to get lawyers. (Do we want lawsuits to be the only option anyway?) If you think the police or state medical board will be an advocate, read elsewhere on this site about that too. Injured patients, as a rule, have no advocate.
2) Healthcare workers virtually never report each other, which means there is no guardian. This is one of the chief components creating the climate in which it is possible to get away with so much in medicine. When a patient has a problem, people in medicine unite against that patient. They protect each other, not
patients who are victims. The only forthcoming witness will be the patient and there is no one for that patient to go to. And the patient can be sued for speaking to the wrong people. 3) It is not uncommon for someone in medicine to want to do something he or she shouldn't. How likely they are to do it is a question, but one that is at least partially is answered by the statistics on how often crimes are committed by
healthcare workers against patients.
I'm not sure anything can be done to make it so that patients are not easy targets. Something needs to be done to provide guardians for patients and a system that will respond to it when patients report having been victimized. Other
healthcare workers never will do this job. They even are in denial about its needing to be done.
So is the society as a whole. One lawyer, speaking about a doctor who had intentionally disabled a patient, said to me that he is sure that the surgeon does a lot more good than harm. I could write a book on my problems with that statement. But I'll just quote someone else instead. Henry Pontell, a professor of
Criminology and author of books about white collar crime, said that someone with the highest pedigree intentionally hurting people is a lot more damaging to our social structure and our institutions than the actions of a common criminal. Remember the point of the movie It's a Wonderful Life with Jimmy Stewart?
The angel shows him all the good that would not have been done if Jimmy Stewart hadn't lived to help all those people. When you measure how much damage is done by a healthcare worker who sins against patients versus how much good that healthcare worker has done, you have to measure all the good that would have been done, but wasn't, by
patients whose lives came to be about surviving the damage done to them, rather than about going out into the world to do good work on other things. The bad the healthcare worker does radiates out effecting many people forever. How do you measure the agony of a patient who no longer provides for his/her children, has a marriage fall
apart, and becomes a recluse after sins committed by a healthcare worker? How can anything make up for that? Especially when the sinner has multiple victims? All those considerations aside, it is not acceptable for the community to play judge and jury by making assumptions about whether or not the sinner should be
reported because of being sure the sinner must do more harm than good. When a crime is committed against someone, the right, legal and moral thing to do is face the criminal justice system. Crime committed in white collar settings, like hospitals and banks, is not understood or appreciated. Actually, most white
collar crime is not one on one. It is not someone saying to a specific person, "I am going to harm you." But in medicine it often is. This is more like what a street thug does than most white collar crime. But they have so many layers to hide behind - expensive lawyers, the ability to destroy evidence, loyal witnesses, the great facade,
etc. Sex abuse of males
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