Bioethics Discussion Blog: “Physician, Heal Thyself”: But Is That Possible?

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Friday, August 25, 2006

“Physician, Heal Thyself”: But Is That Possible?

My visitor, Jaine, in response to the last thread asking for contributions of topics, presented a topic that I have touched upon in various threads but I think is worthy of devoting one specifically to this issue here and now. Jaine wrote:


A topic of interest to me is whether doctors are capable of monitoring their own profession, in an ethical manner, in a punitive system? Only extremely ethical people are capable of remaining objective and honest in a system that punishes members for being honest about mistakes. It is ridiculous, in my opinion, for doctors to promote themselves as being capable of self-governing in an ethical manner in a punitive system, when doctors are subject to human nature, as well as suffering from such things as personality disorders, to the same degree as the rest of the population. The approach encourages setting the standard of care very low to protect even the least skilled doctors instead of demanding doctors develop and maintain a high skill level.

“Critics of the current system say it discourages medical staff from honestly admitting errors, for fear of lawsuits.” Link.

“In Sweden, when a patient suffers avoidable injury, whether through gross negligence, such as a botched surgery, or through a more understandable but avoidable mistake, such as a misdiagnosis or medication error, the patient—usually with help from the doctor's office—fills out a form requesting compensation.” Link.

If anyone has a subscription to the New England Journal of Medicine I’d appreciate being able to read the article offered at entitled “Medical Errors and Medical Narcissism”

The case of Dr. Michael Swango, who is suspected of murdering between 35-60 patients, provides an example that begs questions be asked around what the priority and mindset of the medical system is. Is it to protect doctors or protect patients?

“After Swango's arrest, Stewart told the New York Times, "(His) case shows that the medical establishment will blindly trust the word of a fellow doctor over the word of other witnesses and that the medical profession cannot adequately police itself." Link.




So the issue Jaine brings up is essentially what I summarized in the title of this posting: “Physician Heal Theyself”: But Is That Possible? “Physician Heal Thyself” is a biblical proverb meaning that people should take care of their own defects and not just correct the faults of others.: But do any of my visitors think that physicians have the strength of professionalism and ethics to do that on their own? ..Maurice.

2 Comments:

At Saturday, August 26, 2006 5:07:00 PM, Blogger David B said...

Having had a botched surgery, it's my opinion that some individual physicians are capapble of recognizing error and taking corrective action on behalf of the injured patient.

However, to quote a friend, "It's a tough union." In my case, the medical community in a fairly large city closed ranks and basically conspired to prevent me from having corrective surgery. Fortunately, I had unusual resources in the form of personal relationships with certain physicians due to having worked at a medical school and was able to prevail. After a nine month ordeal of trying to be well, again and being thwarted at seemingly every turn my, own internist (one of the good guys) commented that I was "a marked man" and that he would hate to be me in a medical emergency in that city. That was one elelment in my decision to move to another state.

Working at a medical school and teaching hospital gives one opportunity to see things that the general public is not exposed to and about which the profesion remains in denial. I knew of a number of situations such as how the school retained protected a resident who stalked a hospital staff member and, in fact, broke into her appartment while she was there. Another example is the researcher who was bringing in a lot of money being able to promote the high school graduate, with whom he was carrying on an affair, to a position of authority over licensed professions. He too was ntorious for sexually harrassing female staff, for years, yet was not disciplined.

So, it seems to me that although the profession spouts a lot of stuff about policing itself, through informal relationships, it takes care of its own. Physicians depend on each other for referrals and are loathe to rock the boat.

Also, having worked in a medical school for a number of years, I can comment that medical students are basically normal but they are trained to develop narcissistic personality disorder during residency. Fortunately, in about 10% of the cases, that part of the training fails and out of that accident, we get some ethical physicians.

Readers might be interested in reading "The Citadel," a novel by AJ Cronyn about the peer corruption of a once idealistic young physician. It's too accurate.

 
At Saturday, August 26, 2006 7:11:00 PM, Anonymous Moof said...

At the risk of coming across as being simplistic, I have to say that in spite of the experience of the previous commenter, I do believe that the medical profession is capable of policing itself ... and that the same can be said for almost any profession ...

Like every other walk of life, the medical profession is made of individuals. Some are honest, some are not as honest ... some are altruistic, some ... are not. They are people, plain and simple.

I believe that, of all professions, the medical profession is the single most likely profession to be able to "heal itself" ... to police itself, first of all because of its nature and the nature of the knowledge associated with it, and secondly because in order to judge whether something wrong has been done, other physicians need to be involved. Judges, lawyers, simply do not possess the necessary knowledge make that sort of judgment.

First of all, the constant threat of litigation needs to be lifted, so that all physicians can practice medicine according their knowledge and conscience. Without that constant worry, physicians wouldn't feel the need to "circle their own wounded" in self defense.

Also ... I believe that honest physicians would be the first to want to remove those who are careless, or malicious, from their numbers - since these are the people that cause the rest of them to fight off an undeserved bad reputation.

What I've seen of physicians leads me to believe that the majority of them are honest people who want to do the right thing, but occasionally make mistakes.

Don't we all ...

 

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