From the monthly archives:

November 2008

Failure?

by Brian Carty, MD, MSPH
11-19-2008

Medicine is often about helping people live with impairment.  Even normal aging is about living with an increasing number of limitations.  We don’t welcome them, but life gives them to us anyway.  According to Ecclesiastes 9:11-12, we all eventually become victims of time and chance:

For man also knoweth not his time; as the fishes that are taken in an evil net, and as the birds that are caught in the snare, even so are the sons of men snared in an evil time, when it falleth suddenly upon them.

But life is precious and people cling to it.  Even those with a terminal disease do not wish for death or want to hasten it, despite popular misconceptions about assisted and “rational” suicide.

In “Reflections on Doctors,”  a book of essays written by nurses, one of the essays - “A Physician’s Definition of Failure,” deals with the meaning of medical failure.  The author, a nurse, worked in a rehabilitation unit for patients with brain and spinal cord injuries.  One of her patients, paralyzed and confined to a wheelchair, was once a high school basketball player.

His high school varsity basketball team photo was hung in his room.  One day when the nurse and the medical director, a neurosurgeon, made rounds, she showed the doctor the picture.  When he saw the photo, the medical director became very upset.  Seeing the picture made the medical director feel as if he had failed the patient; he couldn’t “fix” him, restore him to his former state - the basketball player in the photo.

The nurse was shocked.  She says that “had it not been for this doctor’s skill, talent, and vision of rehabilitation, this young man would not have the future he had in front of him.  He would finish high school, go to college, get married, build a successful career, and have children.”

Many people who accomplish much less than this can’t necessarily be considered failures.  Doctors, nurses, and other medical professionals learn early in their careers that many of their patients will never function normally.  However, that shouldn’t stop medical people and their patients from getting on with life.

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Hot Medical Bric-a-Brac

by Brian Carty, MD, MSPH
11-12-2008

Sperm Donors Liable for Child Support

In several court cases, men who donated sperm to female acquaintances or friends now owe child support.

Admittedly, the men did have some periodic contact with the children, and visited or sent presents or cards.  These actions apparently established a “parental relationship.”

How’s that for gratitude?  THANKS!  THANKS!  THANKS!

Medicare Pays Dead Doctors to Take Care of Dead Patients

Have Medicare Bureaucrats Discovered the Magic Elixir - The Secret of Eternal Life?

Between 2000 and 2007 Medicare paid between $60 and $92 million for claims filed by dead doctors .  Some of these doctors had been dead for over ten years when the claims were filed.  Also, millions of dollars have been paid for services provided for dead patients.

Obviously, dead doctors can’t take care of dead patients.  The explanation is fraud.  Someone apparently obtained a list of Medicare patient and physician numbers and fraudulently submitted the claims to Medicare.  The claims were then paid by Medicare.

You would think that Medicare bureaucrats would be able to find a way to stop paying for these fraudulent claims.  After all, aren’t these the geniuses who want to take over the whole health care system?

Could it be that the Medicare employees are the only people in this whole sorry fiasco who are dead?  Brain dead, that is.

He Came Out of the Closet When He Came Out of the Operating Room

A man who had heart surgery in the UK had to have a vein removed from his leg to bypass the blocked arteries in his heart.  Part of a tattoo on the man’s leg, which read “I love women,” was removed along with the vein.  However, after the operation, the tattoo read “I love men.”

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Doctors as Political Tyrants

by Brian Carty, MD, MSPH
11-10-2008

Che Guevara, a murderer and executioner, was also an obstetrician

Aren’t they all tyrants, many doctors’ wives and nurses say, facetiously we hope?  I don’t mean know-it-all physicians who are used to running things and getting their way, but violent political tyrants, dictators, or terrorists.  Doctors can be as violent as anyone else.  Doctors can take as much pleasure in political violence as nonmedical people.

 

Guess what?  Those Terrorists Were Doctors

 

Several would-be terrorists - Muslim doctors, were intercepted in the UK and Ireland  in 2007 before they could carry out bombings.

 

An Ugly Stain on the Medical Profession Which Will Never Be Forgotten

 

The role of World War II Japanese and Nazi doctors in committing medical atrocities and torture is well known.

 

The Unpleasant Truth About Che Guevara

 

Che Guevara, a Marxist revolutionary and an obstetrician, actually took pleasure in executions, as described in “Exposing the Real Che Guevara,” by Humberto Fontova:  

 

There was something seriously wrong with Guevara… (He) seemed to relish it.    He appeared to revel in the bloodletting for its own sake.  You could somehow see it in his face as he watched the men dragged out of their cells. 

 

Whether doctors are more or less likely than average to be terrorists or inflict political violence is difficult to determine.  But how can members of a profession dedicated to compassion and healing become terrorists or political murderers?

 

Cutthroats in White Coats”

 

Theodore Dalrymple, a prison psychiatrist in the UK, in his essay “Cutthroats in White Coats,” discusses some of the reasons why doctors, of all people, might be prone to political violence.  For one thing, Dalrymple feels that medical practice can produce a cynical and disappointing view of human nature.

 

He also says that doctors are exactly the kind of people one would expect to become terrorists.  Not many doctors, but some.  This is in part because they have the right psychological qualifications, in that they have to be dispassionate in the face of suffering, and may have to cause suffering to achieve a benefit. 

 

Ideology – A Set of Political Beliefs, Can Lead People Astray

 

Political violence can result when this emotional distance in the face of suffering is combined with an ideology such as Islamism or Marxism which can lead to sadism and violence.  Educated classes are susceptible to becoming fanatically devoted to certain ideologies which can allow people to commit horrible acts with the intent of somehow producing a better world.  For these people, ideology makes the most absolute evil seem good.

 

Do You Hear a Ticking Sound When Your Doctor Walks Into the Room?

 

So should you put your physician through a metal detector before your next office visit?  Probably not. 

 

A Doctor’s Most Important Possessions Are Reputation and Moral Principles

 

Despite the chilling examples discussed above, the physician terrorist seems to be rare.  However, even one such example shocks us with extreme violations of the ideals of the medical profession.  Those ideals should be affirmed constantly, and there is no better statement of them than by Dr. Tinsley Harrison in the first 1950 edition of Harrison’s Principles of Internal Medicine, generally considered the “bible” of internal medicine:

 

No greater opportunity or obligation can fall the lot of a human being than to be a physician.  In the care of the suffering he needs technical skill, scientific knowledge, and human understanding.  He who uses these with courage, humility, and wisdom will provide a unique service for his fellow man and will build an enduring edifice of character within himself.  The physician should ask of his destiny no more than this, and he should be content with no less.

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Doctor, Are You a “Disruptive Physician?”

by Brian Carty, MD, MSPH
11-06-2008

Dr. X sat at a computer terminal at the nurses desk, angrily punching the keys of the keyboard, looking for his patient’s lab results.  His face flushed a deep crimson.  He shouted “Where are the !?&#%!! lab results!”   

Out of Control

Everyone at the nursing station knew the drill by now.  Dr. X picked up the keyboard, turned it on its side and pounded it on the desk.  The Q-W-E-R-T-Y keys went to the left and the Z-X-C-V-B keys to the right.  Then he raised the keyboard above his head and smashed it against the floor.  Keys and plastic fragments flew in all directions.

As Dr. X stomped off down the hall, the ward secretary pulled out a backup keyboard and began to clean up the mess.  She had a supply of spare keyboards and phones in a closet, ready for the next outburst.

Coworkers Traumatized

The nurse across the desk from the computer terminal covered her face with her hands and cried quietly.  The charge nurse stood in the break room.  She was on the phone with the hospital administrator.  She rolled her eyes as she listened to him say “But he’s our top admitter.”  There was a long pause, and then the administrator said “Look, I’ll call the nursing supervisor.”

Some Behavior is Unacceptable

Behavior such as throwing charts and instruments, shouting, profanity, and the like, is obviously disruptive, unprofessional, and unacceptable.

“Disruptive” Can Be a Catchall Term

However, “disruptive physician” guidelines can be vague and subjective and may be used to harass physicians who challenge the hospital administration on the quality of care provided by the hospital staff.

“Disruptive physician” guidelines allow hospital administrations to dismiss doctors from hospital medical staffs for actions such as refusing to join a hospital-sponsored HMO, offering a service that competes with the hospital, expressing political views that are disagreeable to the hospital administration, and voicing concerns about quality of care.  

Shabby Treatment of One Physician

The case of Dr. W, a surgeon at a Charleston, SC hospital, illustrates these concerns.  Dr. W openly complained about the quality of care his patients received at the hospital.  The hospital subsequently accused him of being a “disruptive physician.”

Dr. W Had Legitimate Complaints 

Here are some problems Dr. W complained about.  Dr. W ordered antibiotics for a woman with abdominal pain caused by diverticulitis, a serious infection of the colon.  The antibiotics were not given for ten hours.  The woman suffered a perforated colon and spent a month in intensive care.  In another case, vital signs (temperature, pulse, blood pressure, and respiratory rate) of one of Dr. W’s patients were not checked for 48 hours. 

Is Making a Written Complaint “Disruptive Behavior?”

Dr. W made a number of written complaints to the hospital administration regarding such deficiencies in medical care. The hospital then claimed that Dr. W was guilty of disruptive behavior.  The episodes of disruptive behavior were these written complaints.

A Good Doctor Is Ruined For Trying to Do a Good Job

The hospital summarily dismissed Dr. W from the hospital staff.  The hospital then reported him to the national data base for doctors who have malpractice suits or disciplinary actions - the National Practitioner Data Bank (NPDB). His practice is ruined, and the NPDB report has made him virtually unemployable.

“Disruptive” Hospital Administrators

It’s interesting that there are no “disruptive hospital administrator” or “disruptive CEO” guidelines.  A CEO may fire a highly competent doctor who is trying to insure quality medical care.  Of course, in doing this, the CEO is being highly disruptive.

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Some Hot and Funky Medical Revenge

by Brian Carty, MD, MSPH
11-02-2008

For the right person, for an ambitious, scholarly physician who thrives on an atmosphere of intellectual competition and one-upmanship, academic medicine can be an exhilarating career.  On the other hand, there seem to be many bright but cynical and sarcastic doctors in academic medicine.  Revenge against one of these people by one of my colleagues is the subject of today’s post.

Parallels to Poe’s Short Story “The Cask of Amontillado”

My colleague’s desire for revenge grew over a long period of time, as did a similar desire in the protagonist of Edgar Allen Poe’s tale of revenge “The Cask of Amontillado.”  In that story, the narrator lures his victim, a wine connoisseur, into a wine cellar on the pretext of offering him a sample of a rare wine, Amontillado.  Poe’s narrator says in the opening sentence that…

The thousand injuries of Fortunato I had borne as best I could, but when he ventured upon insult, I vowed revenge.

Poe’s narrator buries his victim alive.  The payback in my story was not so extreme, but it was unique and humiliating.

Chief, Department of Insults and Abuse

In today’s post, the object of revenge - the chief of a clinical department, was no ordinary bully.  He was enormously insulting and vindictive, almost always without justification, and he was universally disliked.  Let’s call him Dr. Anu.

The details of Dr. Anu’s behavior and whether he deserved such dislike can’t be discussed here.  For now, you’ll have to take my word for it.

A Superdoc Has Had Enough

My friend who inflicted the comeuppance was a highly intelligent, skilled and conscientious physician.  Along with everyone else, he had endured Anu’s insults and abuse.  My friend was leaving the hospital to train at a very prestigious academic medical center, and he despised Anu. 

On my friend’s last day of work, as a parting gesture of affection, he pooped in a shoe box and left it on Anu’s desk.

This incident occurred years ago.  However, I only realized when I started to write up this piece that when Anu found the box, his misery was only beginning. 

What Is That Awful Smell?

Leaving it in the trash can would not be a good option.  First, he would have to abandon his office for the rest of the day.  Then, what if Anu went home, leaving the box in the trash can?  What if the cleaning staff or other employees entered his office to investigate the stench and found the box?  Hundreds of people would find out through the hospital grapevine.  The lack of any obvious explanation for the mess would make the story even more sensational and worthy of gossip. 

Hey Doc, What’s In the Box?

Did he take the smelly box out of his office and throw it away?  In that case, the entire hall would have smelled and people might have noticed.  They would have wondered:  Did Anu soil himself?  Did he contaminate himself with stool from a patient?  If Anu encountered another colleague or employee in the hall while carrying the box, would he have tried to explain the situation?  Wouldn’t the true explanation be the most embarrassing explanation of all?

Anyway, I Think the Statute of Limitations Has Run Out

Certain people can probably identify the relevant parties in this story.  Too bad.  Anu deserved his punishment, and my friend was proud of what he did.  I’m proud of my friend, too.

So remember, revenge is a dish which is best served steaming hot.

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