Hypocrisy: Do You See It in the Practice of Medicine?
Hypocrisy is a word in the news these days. Currently it is being used in the context of the alleged behavior of U.S. Senator Craig as contrasted with his prior pronouncements and governmental activities. The word is defined in various ways but essentially can be understood as insincerity by virtue of pretending to have qualities or beliefs that one does not really have. My interest in using this word on this blog is to discover if hypocrisy is absent or is present, perhaps flagrantly present within medical practice and the various components that make up medical care from the pharmaceutical companies, insurance companies and HMOs,to the various medical societies including the American Medical Association, to the hospitals and down to the individual physicians, nurses and technicians involved in the care of patients. Do my visitors feel that at any level of health care, there are qualities or beliefs that are expressed to patients but by actions are really not present and not considered when dealing with society, patient groups and individual patients? If present, in what ways do you see it expressed? What do you think? ..Maurice.
posted by Maurice Bernstein, M.D. @ 4:50:00 PM
14 comments
14 Comments:
Oops! To be fair and complete, I must admit that I unintendedly left out in the list of components of medical care the medical schools and the schools teaching the nurses and technicians. Do they present to the public the quality of their goals and products which are beyond what is their reasonable or practical intentions? Or do they express to the public a fair representation of what were their intentions with regard to their final graduate product? ..Maurice.
To get started on this topic, I found an interesting article by Mark Burrell in the Journal of Contemporary Psychotherapy (vol. 17, number 1, March 1987) titled "Psychotherapy and the Medical Model: The Hypocrisy of Health Insurance." The Abstract defines the writer's concerns but also provides us with an example of how provider behavior may appear hypocritical:
Psychotherapists manifest a severe discrepancy between practice and preachment when they espouse rejection of a medical model of human problems and psychotherapyand accept health insurance for their work. When psychotherapists accept health insurance they classify their actions and their client''s problems as medical or quasi-medical entities, confuse the literal and metaphoric definitions of illness and treatment, and support the medical model. Acceptance of health insurance may serve numerous functions including: symbolic legitimization of psychotherapists; monetary gain; and the obfuscation of moral/social issues. Accepting health insurance while criticizing the medical view is hypocritical and interferes with understanding human problems. ..Maurice.
Dr. B... I was thinking more along the lines on how we are taught to treat "pain" and how we actually treat pain.
We are told as health care professionals that pain is judged by the patient's perspective not ours.
The hospital in which I work, we pass out little pamplets in triage that tells the patients how we should be managing their pain.
Now, as much as I am ashamed to admit this out loud, if a patient arrives to the ER with a bag of McDonald's fries and is chomping down the fries along with his coke and he's telling me he has number 10 abdominal pain, I'm sorry, chances are I'm thinking he's not in that much pain.
But....if you want to take what we are taught to the fullest, I should believe him without a doubt until I can prove otherwise.
Talk about hypocrisy. I'm being a hypocrite for not believing him but I still pass out the required pain pamphlet.
And I have to admit it, there are times I've rolled my eyes when the Doctor prescriped Demerol and phenergan to the patient who is in "excruciating abdominal pain," but is laughing and joking with a room full of visitors.
I don't know what the answer is, but I have to admit, hypocrisy seems to be in my volcabulary.
I'm ashamed, I'll hang my head now.
The "literal" meaning of 'hypocrisy' is too little, or insufficient criticality, particularly with regard to one's own behavior. Of course there's hypocrisy in medicine -- it's a human practice after all. That doesn't mean we shouldn't strive mightily to eliminate hypocrisy. But we shouldn't ever pretend that we have succeeded in doing so. Constant vigilance is in order.
Bob, but isn't there some duties and responsibilities in society, such as medicine, where hypocrisy, despite being a "human practice" is intolerable. How about the fiduciary responsibility to patients? How can patients trust their doctors if the doctor, in addition to medicine, practices hypocrisy? Also who is to provide the "constant vigilance"? Would it be the physician him(her)self? But would that really be effective and even realistic? And for an outside party to be constantly vigilant would be difficult since it would require discovery of the hidden views or attitudes or intentions of the physician. Any suggestions on how to strive to eliminate hypocrisy especially in the healthcare system? ..Maurice.
Maurice - I see hypocrisy as fundamentally a matter of personal integrity -- a question of "consistency" between thought and action. I suspect that most patients don't care a great deal about the ethical integrity of their physicians, so long as they get reasonably good health care. But physicians, as moral agents, should certainly be quite concerned about their personal integrity. And since personal integrity must be the ultimate "foundation" of professional integrity, the medical profession itself should be concerned with the personal integrity of its members. So the profession has a duty to expose and marginalize hypocrites who don't make sincere efforts to maintain consistency between their thoughts and actions.
My response, Bob, would be why shouldn't or wouldn't a patient care about the ethical integrity of their physician. Surely, a patient suspecting unethical behavior of their doctor can extrapolate the possiblity of impaired treatment and care sometime in the future regardless of the current management.
Returning to the Senator Craig example, wouldn't those who could vote and those who voted him into power expect in making their decisions, assume that Senator Craig actions would be based on his personal thoughts of an issue and not acted out simply for his political benefit. They voted or didn't vote for him for their own benefit. ..Maurice.
I think patients could make the extrapolation you describe, but I think most of the time patients only expect doctors to provide expert health care, not to provide role models for ethical integrity. Still, when a lack of integrity becomes known, it is natural and appropriate to question whether the doctor in question can be trusted to promote the patient's well-being.
I don't think, though, that the case of hypocritical politicians is quite analogous to the case of medical professionals. Politicians present themselves as champions of various social-political values, so people do expect them to be role models -- to practice what they preach. In contrast, what social-political values a physician espouses should be completely irrelevant to the quality of the health care they provide.
I wonder if this could include specialists who do not do a full exam, even in those areas that are part of their specialization because it might take a few more minutes. It seems to me that we sometimes get abbreviated exams even when sent to a doctor for a consultation where one hour is set aside on the charge sheet.
Are doctors, clinics, and hospitals so short on time that it is forcing them to cut out parts of what used to be a full evaluation? I am 46 and am finding that I am going to have to start asking for a genital and prostate exam because even oncologists who have this as part of their specialty are skipping these exams.
I have been exposed to massive amounts of radiation and chemo and my doctors know this, so I do not want to develop a problems because my doctors decided to skip part of the exam.
They have no problems with scheduling several thousand dollars worth of diagnostic tests but won't do a full physical.
Am I expecting too much from my doctors?
I think you have given an example of hypocrisy in medical practice: offering oneself as an oncologist specializing in genital disease but not practicing their specialty to the standards of their specialty. This can lead to patients question whether the physician,as Bob Koepp noted,"can be trusted to promote the patient's well-being."
..Maurice.
What I am finding is that I can't really expect a doctor to always check things that are within their stated area of expertise because they tend to focus on only one thing and forget to even do a full physical exam. I hope it is just tunnel vision.
When a group of doctors are all doing this, it begins to look like it is standard policy and not just one doctor deciding to skip part of the exam.
It makes me question if they could be missing something obvious. I have had a lot of expensive scans of various types and lots of blood tests and have been seen by 5 different specialists and not a single one of then has looked at anything below the belt line.
I see one of the oncologists in 4 days and I am going to insist on a more thorough exam in order to make sure that they aren't looking in all the wrong places.
Seems really odd to me that a group of doctors with an average of 20+ years experience would need a patient to speak up and point out what they aren't doing. I keep thinking that they can't be this dense, but I am beginning to wonder.
(I was having comp trouble, hope this comment doesn't post twice)
When talking with my surgeon before my cancer operation in a teaching hospital, I asked how much participation the residents would have in my operation. He told me that he allows the residents to perform most or even all of the operation if he feels they are qualified. I expressed alarm that I thought he would be the surgeon, and that I had chosen him for his reputation and experience. He reminded me that this was a teaching hospital and if I was uncomfortable, I should go elsewhere. I was taken aback that insured or private patients could be denied care if they refused to provide their bodies to surgeons in training to practice on, even to the point of performing the entire operation.
Dr. Atul Gawande in his book "Complications", written while he was a resident at Johns Hopkins, describes in the first chapter how his learning was "stolen from the patient, their bodies taken as eminent domain hidden behind drapes and anesthesia" He then referred to a physician who was a mentor to many doctors in training, and was very generous in allowing hands-on participation in the operating room, even to medical students. This physician's wife was in the hospital and had just delivered. Gawande asks:
"So did you let the resident deliver? Silent pause. No, admitted the physician. 'We didn't even allow residents in the room.' I, myself, refused to let a fellow treat my son who had a severe cardiac defect, opting for the very experienced pediatric cardiologist-in-chief at my hospital. I wasn't even torn by this decision, after all, this was my child." Gawande goes on to say:
"Given a choice, people wriggle out (of care by doctors in training), and those choices are not offered equally. They belong to the connected and the knowledgable, to insiders over outsiders, to the doctor's child but not the truck driver's."
Dr. Bernstein, is this doctor's description of double standards in teaching hospitals commonplace?
Isn't this medical hypocrisy?
I suspect that the story which "a patient" noted more likely represents a "double standard" rather than hypocrisy. From Wikipedia:
Merriam-Webster defines hypocrisy as "a feigning to be what one is not or to believe what one does not."
Webster's New World Dictionary defines it thus: "A pretending to be what one is not, or to feel what one does not feel, especially a pretense of virtue, piety, etc." It defines hypocrite as follows: "a person who pretends to be what he is not, one who pretends to be better than he really is."
Since the root of the word comes from actors acting a part, the definition as laid out in dictionaries makes sense.
A double standard, according to the World Book Dictionary, is a standard applied more leniently to one group than to another.
There is a distinction to be made between double standards and hypocrisy, which implies the stated or presumed acceptance of a single standard a person claims to hold himself or herself accountable to, but which in practice may be disregarded. If a man believes it is his right to have extra-marital affairs, but that his wife does not have such a right, he holds a double standard. A man who pretends to condemn all adultery while maintaining a mistress is a hypocrite.
..Maurice.
Here is a poem, thanks to PoetryArchive, which may express the "value" of hypocrisy. ..Maurice.
HYPOCRISY
by: Samuel Butler (1612-1680)
HYPOCRISY will serve as well
To propogate a church as zeal;
As persecution and promotion
Do equally advance devotion:
So round white stones will serve, they say,
As well as eggs to make hens lay.
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