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Full Table of Contents
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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.
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Greed
Patients will not be safe
as long as safety depends on healthcare to care more about patients than profits.
Once upon a time in medicine, a doctor fresh out of medical
school could go to a bank and borrow money to set up a practice. That provided
the wherewithal to build up a profitable practice in which they might not charge
as much to some patients as others, for instance, patients that had needs that were greater than
their income still could have taken. In short, doctors could focus on their patients and find ways to help
them - not a bad focus to germinate in doctors.
Today doctors fresh out of medical school carry hundreds of
thousands of dollars of debt. Not only will no one loan them more money, they
have to establish income immediately to begin paying off their debts. So they
have to go to work for someone like a hospital where they have no control over
who they see or how much is charged or how the practice is managed. So they
don't get to exercise the most human side of their profession. Instead, they
learn routines that are good for bureaucracies even when they are not good for
patients.
Hospitals, even ones registered as non-profit, figure out how
to do things like divert patients to the most profitable treatments, even
diverting non-emergency cases to the emergency room where the fee can jump a
thousand dollars for the same service. Young physicians might not always
recognize the motivations behind the patient-management practices that become
routine for them. And they don't get to become part of the patient community in
the same was as they did once upon a time. They have huge bills to pay and they
are in the service of bureaucracies that are more profit oriented than a lone
doctor likely would have been.
Greed in medicine is not just individual doctors wanting to line their own
pockets. It is things like the HMOs. HMOs have been called the spawning ground
for those more interested in making money than in healing patients. Big
insurance used to be considered the bad guys in medicine. HMOs were supposed to
correct for that, but some say they have become even worse, and now are selling
their profitable businesses to big insurance.
There is an inertia. There is a culture. Try to be a nurse
who wants to sit for a moment with a patient and hold his or her hand through a
bad time. There isn't time. Insurance doesn't want to pay for that and hospitals
can't charge for that and the nurse and the patient cannot be humans or
neighbors or friends for that moment. The bottom line won't allow it. The
practices that young doctors and nurses learn (perhaps reluctantly) feed the bottom line at all costs.
Especially in the way they absorb how to avoid accountability - the risk
management practices they learn, without always knowing the motivations behind
them, that hide errors and negligence and bad practices and even sins committed
against patients so that medicine neither pays for nor learns from them as they
are committed over and over again, year after year, by humans who may originally
have had noble motivations but now are so mired in the culture they believe in
that they don't see the problems. And they don't recognize their own
insensitivities and greed or the greed of the system.
It used to be that drug studies were conducted by
universities. But the drug companies found it faster and cheaper to conduct the
studies through "clinical investigators," which means neighborhood doctors who
can earn a thousand dollars per patient for putting patients on drugs and
watching how they do. The safety of the data (and, by the way, the patients)
depends on all those doctors being saints feeling no greed. It is profitable for
the medical community to make that assumption. Their perspective, their
interest, is not discovering the extent to which, and the many ways in which,
greed in medicine undermines the well-being and the safety of patients. They
have disincentives for measuring the outcomes for patients against their profits. They keep
track of their own profits, not the long term
effects for patients. Greed is disinterested in the costs for the patients.
Patients need more data and more sunshine in order to be
better shoppers to adjust for the greed of the system. Patients never will be safe as long as
safety depends on healthcare to care more about patients than profits.
Example
There is a basic to-do list
that saves lives in hospitals. It is not new information. It merely is
information that healthcare professionals have not bothered to use. It has to do
with the sterilization steps taken when inserting a central venous catheter.
80,000 per year get infected. 28,000 per year die as a result. But in hospitals
where the to-do list was followed the catheter-related infection rate dropped to
zero. If hospitals and physicians were paid according to outcomes, all of them
already would be following that to-do list. Greed motivates them more than the
outcomes for their patients or they would be using these ways and others to keep
patients safe.
Another Example
Greed doesn't necessarily mean money immediately. It can mean
wanting the status and career advancement that lead to money. Even scientists
researching medicine are not immune to greed and its equivalent.
Andrew Vickers, a statistician who designs and analyzes
cancer studies, has written about the difficulty of getting scientists to share
data, even scientists who are federally employed. Mr. Vickers knew of a study
about a certain drug for treating one type of cancer, but almost no one was
using it because it didn't work very well and had some side effects. However, a
colleague showed that a protein found in the blood could predict which patients
could benefit from it. And it turned out that the researchers who did the
original study had measured that protein in all of their patients. All that
needed to be done was a new analysis of the data to study this link. There was a
group of sick patients who could benefit from this. But the original researchers
would not reveal the data because they thought they might want to do that
research themselves someday. Years passed without their doing it. Patients with
a dire need did not benefit while scientists kept secret data that they
themselves hoped to benefit from studying someday - if they ever got around to
it. They haven't yet (see Vickers article in the New York Times, 1/22/08, pg
D5).
One of the criticisms of academic researchers is that they
are divided into fiefdoms that do not cooperate. Their chief drive is to publish
papers and take credit for discoveries, not heal patients. Whether it is inside
of academia or not, scientists don't like to be scooped or have their
conclusions challenged. That disinclines them to sharing and cooperating. If
saving the lives of patients were the motivating force, sharing and cooperating
would be attractive and sought after. But status and career motivate them more.
Of course, scientists are not supposed to be concerned about whether an subject
has immediate practical application. The benefits of scientific research may be
much greater in the long-term than in the short-term. They are supposed to be
above worrying about that in order to pursue investigations that further
understanding and knowledge. But those ends are served less well by refusing to
share data and planning work to benefit career and status rather than science.
And they are worrying about career and status more than the lives of patients.
The same motivations are true of physicians and nurses and
hospital administrators. Good will and innocent altruism are not at the top of
the list of their motivations despite all the verbiage to the contrary. Patient
safety initiatives that assume that they are have been founded on false
principles. The biggest problems for patients cannot be cured by initiatives
founded on false principles. Having any of these people sign another promise to
hold the well being of patients as their first and foremost concern simply is
naive.
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