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Medical Ethics

Medicine Can Be A Taunting, Vicious Profession At Times

By Birdstrike MD   Not too long ago, I was busy at work seeing patients. The secretary yelled, “Dr. Birdstrike, there’s a phone call for you.” “Alright,” I said. “Transfer it over.” I answered the phone. “Hello, Dr. Birdstrike, this is ***** ****** from the ****** State Medical Board,” said a jabbing, deep military sounding voice. “Uh…hello,” I said. I felt a jolt of electricity in my chest. This wasn’t a phone call I expected nor wanted. The state —-ing medical board? What, the…? “I’m calling to notify you, we’ve received a formal complaint about your medical practice and I’ve been assigned as the lead investigator.” At this point, the adrenaline was pumping through my veins, and my heart beating fast enough, that I didn’t hear much of what he said after that. He might as well have told me I had brain cancer and had 6 agonizing weeks to live. Although I have been sued before, though never convicted by a jury, of medical malpractice, I’d come to realize that whole process was more about one group of lawyers fighting with another group of lawyers, to get money from an insurance company, with a doctor and a patient as mere pawns in the game. It’s a game that can feel very personal, but ultimately isn’t, and is mostly about the trophy hoped for by the plaintiff’s attorneys: Award money. But a complaint from the medical board? It’s honestly something I never thought I’d have to face, having been someone that’s always performed at a very high level during my career, at all of it’s stages, not every having faced any significant concerns regarding my performance. Also, in my personal life, I am, for lack of a better word, a rule follower. After, the initial shock dissipated, his words gradually faded back into the ear of my consciousness. He gave me the name of the patient and the stated complaint. I remembered the patient, but I didn’t remember any particularly bad outcome, or any negative interaction or administrative complaint at the time. The accusation appeared out-of-place and baseless. He explained the process: I was responsible for providing a written response to the medical board within 15 days. After that, there would be an investigation. After an undetermined period of time, the complaint would either be dismissed outright, dismissed with a non-disciplinary letter of warning which would go in my medical-license file, or if neither of those, then I’d have to go before the medical board for a hearing. A licensing hearing? The entire thought of any of this was horrifying. News headlines of doctors who had lost their licenses for egregious and horrible misconduct flashed like shocking, intrusive, strobe-light banner-notifications across the home-screen of my brain. I did nothing wrong. Why is this happening to me? This is insane? What the —-? Am I going to lose my license? No way, I’m going to lose my license. I did nothing wrong. Nothing even happened. Wait, what happened? Did anything happen? No, nothing did. But what if I get some rogue medical board or the case is reviewed by someone with an axe to grind or from a totally different specialty? Miscarriages of justice happen all the time. Don’t they? Questions bounced around my brain like a silver pinball. I slowed my breathing down. I logged into the medical record scanning through charts and reports like a DVR player on fast forward. Wait….They have no case. THEY.   HAVE.   NO.   CASE. I started to get angry, very angry. Just like my lawsuit, where I was falsely accused of malpractice, ...

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Hospital Video Surveillance

Should hospitals be required to notify patients that the patients may be subject to video monitoring? Dr. Tim Lahey, the author of the New York Times article titled “A Watchful Eye in Hospitals” and chairman of the Dartmouth-Hitchcock Bioethics Committee thinks so. Not only that, Dr. Lahey believes that hidden video cameras should be only a “last resort” and should only occur with the oversight of a hospital ethics committee. The horse is out of the barn on this one. Society has become too Orwellian to retreat into an expectation of more privacy. Video monitoring occurs everywhere – courthouses, grocery stores, airports, spy drones, even many private homes. You’d be hard pressed to find any hospital in the nation that doesn’t already use some form of video surveillance. In fact, in the next 5-10 years I predict that audio or even video recording of patient encounters will become commonplace – much like police encounters are recorded now. A proposal requiring hospital ethics committee oversight to use video surveillance when those committees typically meet four times per year (and some hospitals don’t even have ethics committees) is shortsighted and silly. For the sake of argument, suppose that a notification of potential covert video monitoring is contained in the documents a patient signs when entering the hospital. Is there some benefit that the notification provides to the patient? Should a patient be able to refuse video surveillance? If so, shouldn’t the hospital be allowed to refuse medical care to patients that do not consent? Kind of like walking into an airport and refusing to be video recorded. If you don’t want to be videotaped, find another means of travel. For now, smile … if you enter a hospital, you’re going to be on camera. Ethics committee approval notwithstanding. [yop_poll id=”7″]

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Why Patient “Satisfaction” Could Be Making You Sick

By  Birdstrike MD All patients should be treated with professionalism and respect.  We all want our patients leaving our care happy, healthy and satisfied, if at all possible.  However, sometimes patients don’t leave an Emergency Department very happy or satisfied.  Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the treating physician did, or didn’t do.  The reasons for a patient being dissatisfied with a particular healthcare encounter can be very complex.  It’s not so simple as to just include a line in a survey such as, “Were you satisfied with your doctor?”  Who should be held responsible for the results of these surveys, is where the crux of this debate lies. So why are Hospitals obsessed with “patient satisfaction”? It’s the same reason Walmart puts greeters at the front door (the ED), not the back door (in-patient floors) and the same reason the Government collects taxes and not sea shells: Money.  The question we really need to be asking is: Why is the obsession with patient satisfaction in the ED so soul-crushing to those that work there?  1-Lack of Control A patient pulls into the ED parking lot.  The lot is full.  He doesn’t feel well, he’s in a hurry and having to search for a parking spot irritates him.  The wait to see a doctor is long, too long.  Once finally in his room, he sees a drop of blood on the floor from the previous patient.  He’s disgusted.  Despite great care by the doctor, it biases his overall view of the experience.  As much as he tries to remain objective, the patient satisfaction score suffers.  The patient gives a “1 star out of 5” review after discharge, but writes in the comments, “Doctor and nurse were great, though!”  The tabulated score remains 1/5, or “FAIL.”  The doctor gets pulled aside at her next group meeting and is told she’s on watch due to low scores.  She’s never been fired from a job in her life, but now her job is in jeopardy, over something which she has no control. A patient leaves an ED satisfied.  He gets a patient satisfaction survey and throws it aside.  He has no need for it.  The visit went great.  It’s his preferred hospital for anytime he gets in a bar fight and needs to be sewed up.  He got in, got his knuckles stitched, and got a free Sierra mist and a meal tray.  On his way out the door, he tweets, “#CityGeneralERrocks!” on his smart phone to the world’s prospective ER “customers.”  Six weeks later, all has healed well, and there’s barely a scar.  Then, the bill comes.  “!&@!?#€!!!,” he thinks.  “$920?  Screw that place!”  He grabs the survey and nukes the hospital, doctor and nurse all with the lowest score possible.  He writes in the comments, “I would have rated you a ‘negative infinity’ if the scale went that low!” You can save a life, walk out of the trauma bay drained but proud, and be pulled aside and told that on last months survey, you didn’t get a patient a coffee “like they do at the car dealership.”  You are told, “Get those scores up.  Administration is watching.”  It translates into, “You suck.”  It’s not that big of a deal, right?  Maybe you should brush it off, but you are human.  You haven’t “evolved” to the “new way” yet.  You’ve heard of ER doctors losing their group contracts and therefore their jobs over things like this.  It bothers you. There’s a complete and utter ...

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Anonymous Physician Blogging: Unethical or Important Check and Balance?

By Birdstrike M.D.   “Don’t ask me nothin’ about nothin’, I just might tell you the truth.” – Bob Dylan   I just read an interesting post by Jennifer Gunter M.D. on KevinMD.com. Apparently, the entirety of what we are doing here at DrWhitecoat.com, and on internet communities and blogs like Student Doctor Network and Sermo, is unethical, according to the General Medical Council in Britain. How dare we not use our real names on social media as physicians and physicians-in-training? According to the British General Medical Council, “If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name.” Otherwise, if you don’t, what you are doing is wrong, and unethical.  Really?  On one hand, I agree that any physician that posts publicly should post with the assumption that their identity could easily be discovered, if desired. Therefore, never post anything anonymously that you couldn’t live with, if your name ever ended up being attached to it. We shouldn’t be mocking patients, using profanity, or blogging like drunken sailors. Also, patient cases need to be devoid of all identifying information (18 HIPPAA identifiers) or even fictionalized to the extent that no patient could ever read a post and say, “That was me!” (For this reason, anything I post that resembles a “patient case,” if inspired by real events, has all of those factors deleted or changed so drastically, that the final product bears almost no resemblance to the inspiring event. The “facts” are drastically altered to the level of fiction, without altering the essential “truth,” hence the disclaimer, at the bottom of my posts.) Dr. Gunter, in her post, links to another blog with some very good points by Christopher McCann, where the need for some level of anonymity is essential for the needed role of whistleblowers. Just think of how many medical disasters, scandals and ethical horrors that could have been exposed or stopped if internet social media had existed in the past with the ability to retain a vague hope of at least temporary anonymity.  I think an outright ban on physicians posting under pseudonyms in the names of “ethics,” creates a chilling effect against speaking out against policies and procedures that may be harmful and unethical themselves.  Such a policy itself is an unethical policy, in my opinion.  In short, it suppresses free speech.  There are plenty of people in positions of great money and power, with a vested interest in enforcing such a chilling effect on free speech. “Don’t dare question, that which you see. Don’t rock the boat. Get in line ‘little soldier’. Don’t get in the way of our immensely profitable status quo.” Because one has a famous “real” name doesn’t make what he says, “Fact.” Just think of how much medical dogma in history, that has caused irreparable harm and was promoted proudly, authoritatively, and unquestionably by big “names” without basis in fact or evidence: bleeding patients with leeches, tapeworms for weight loss, lobotomies, smoking to treat asthma, heroin prescribed for the common cold in children, using mercury to treat syphilis, all the way to modern day unnecessary surgeries. How could I forget the Tuskegee Syphilis experiment, conducted by the US Public Health Service itself, where 600 African American men were allowed to rot with syphilis, and were never offered the cure when penicillin was invented? These were all treatments that were accepted by the medical community at the time and touted by doctors who weren’t afraid to use their “real” names.  Perhaps they should have been afraid, and perhaps if there had been an ...

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