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Expectations influence perception.
Ever try to get iatrogenic injuries diagnosed and treated? Good luck.
There is a list of reasons defeating succeeding with that. For one thing, the knee jerk reaction of health care professionals is that your claim is frivolous. They just don’t believe you. But there are more reasons.
For one thing, there won’t be any record of it. For another, the person who caused it will brand you as a difficult patient, at the least, and spread lies about you. For another, it can damage the career of a health care professional to diagnose iatrogenic injuries because the rest of the medical community will turn on him or her for doing that. And “you can’t let one patient ruin your whole career.”
There are more reasons beyond those, but the point is that patients who have been injured by their treatment providers are treated differently than other patients.
As Nate Silver says, in the book at left, we unconsciously let biases based on expectation or self-interest affect our analysis.
Doctors are not supposed to be critical of other doctors. That is a matter of law some places. It is both an unwritten and a written law. If they violate it, their own careers can be hurt – a highly influential self-interest that gets little recognition in a world that imagines itself to be above self-interest.
What health care providers are willing to believe is strongly effected by what result those beliefs will have on themselves and their profession as a whole. They are better off imagining that all those injured patients are frivolous cranks. Then they can do things they can rationalize when imagining themselves or their group to be under attack.
They don’t believe they injure patients
You could be excused for thinking that since they caused the injuries to the patient that patient should be their next patient. They do not think that way.
What makes sense to them is defense and denial. What doesn’t make sense to them they don’t write down.
When injured patients submit themselves for treatment to physicians who don’t believe what the patients report, no record is made of it.
Actually, if they do believe it they probably are even less likely to make a record of it ( see loyalty). If they feel the need to note something about why the patient was there, they may ask a series of questions, or perhaps the same question in a series of different ways, until an answer is given that they are comfortable writing down.
- “When did you first notice the symptom?”
- “How long after the operation was it before you THOUGHT you noticed this?”
- “Was there ever a time prior to this when you had a similar symptom?”
- “Have you ever had an accident or sports injury or illness that produced a similar symptom?”
It is a cross examination fishing for any piece of information that can be used to reject the patient’s claim. If twenty questions do not do that, but the twenty-first can be repeated out of context in a way that will seem to, that can get written in the record.
Living in a fictitious world built on a denial of facts.
If they never get an answer they want to put in the record, they still aren’t likely to record any of the ones that they don’t like. The patient probably will be asked if he/she has been back to see the surgeon (or whoever injured the patient). If not, that is the course of action that will be recommended and the appointment effectively will be over.
Any real attempt to examine the patient will be unlikely, in part because no one in medicine wants to verify injuries that could be used to indict someone else in medicine, and in part because no one in medicine wants to get dragged into court to testify. If the patient has been back to the surgeon already, the doctor usually will ask what the surgeon said, and it almost doesn’t matter what the patient reports about that. The doctor will agree, often by saying something like “Well, that surgeon has a very fine reputation and I’m confident that he/she knows what he/she is talking about.” But no real exam, and no record of the patient’s claim. Even if the patient is poked and prodded, even if a CT scan is done because the patient demanded it. When these things are done by people who do not want to find injuries, they don’t.
Sunshine can deprive bad actors of the secrecy needed to act badly
When a doctor, either the one who caused the injuries or one of the ones applied to for help, labels the patient as crazy and telegraphs that to other doctors, along with the notion that this patient could harm a colleague, a received view emerges in the medical community to which all others unthinkingly conform. They don’t recognize their own self-interested cloud of clichés, false assumptions and lies as they turn the white wall of silence into into a blacklist with nothing more than a phone call or a nuance in a referral negatively branding the injured patient. This isn’t just remaining silent. This is going further and spreading the word to make sure others do too.
Interestingly, when they no longer can deny that a colleague was, for instance, a serial killer, health care professionals who are asked why they don’t report colleagues who are murdering patients, sometimes say things like that they didn’t because the system lacks a way to spread the word (see Cullen). But when the problem is the fact that the reputation of another health care professional could be blemished, they find lots of ways to spread words to prevent that.
A surreal level of honesty
Physicians assume a level of honesty from their peers that is beyond what reasonably can be expected from human beings. They do not anticipate the obfuscation of having caused injuries to patients. Apparently they imagine that those who injure patients, either accidentally or on purpose, will not have rationalized their behavior, even to the point of not recognizing their own behavior, and will write in the record what they did that injured the patients. In fact, the standard behavior is to not write in the record that there are injuries.
A patient arriving claiming to have been injured by another health care professional cannot get this next one to make such a record either. Instead, the patient tends to be regarded as a crazy person who potentially could ruin the career of an innocent colleague. When most injured patients are treated differently than all other patients, isn’t that really just profiling? And in what way does that produce a different result than blacklisting?
There also can be some influence from what some have called institutional blindness. Like if you went to the police to report that while you were away some of your possessions had been stolen, all the police would know for sure is that you are reporting that you cannot find some of your possessions. They do not know who else has keys to your home or what else might account for their being missing and so write down only what they know, that you are reporting possessions being missing. Medical records written in this way at least would record that you have complaints and believe you have been injured, even if they do not record the who, what and where of the cause you have reported.
However, when medicine will not even acknowledge that there are injuries, that pushes it beyond mere blindness. Patients seeking only medical help are asked how they got injured and, if they answer that someone else in medicine caused it, open up a world of medacity and manipulation that further injures them. If they look at their records later they can find fanciful, if not pejorative, statements claiming the patient reported the opposite of what the patient reported. That’s doctors lying.
C43.4 is one of the diagnosis codes that could appear in your record after trying to get treatment for an iatrogenic injury. It is part of the the International Classification of Diseases, Tenth Revision (ICD-10) which has more than 141,000 codes. You can look up the codes on the internet by searching on “ICD-10 codes” to see what the codes in your chart mean (the links to that keep changing). C43.4 is the code for “Malignant Neoplasm of the Neck,” which is a supposed to identify a particular physical problem in your neck (most commonly suspicious masses and adenopathy), but also can be a way to communicate to other caregivers that you are a pain in the neck.
F68.1 is the code that more transparently identifies a patient believed to be feigning symptoms or disabilities. Unfortunately, with electronic records, these diagnoses can follow patients forever.
Health care professionals also can find ways to protect their careers and their belief in their profession by imagining that the patient has Somatoform disorder. In Somatoform disorder, the patient does not consciously feign symptoms (which would be known as facetious disorder) or fabricate them in order to get or achieve something (known as malingering), but actually believes he/she has real injuries. Odd when, in fact, it is the health care professionals who actually believe that the patient who has real injuries doesn’t.
There are many words for diagnosing what health care professionals have an interest in believing to be incorrect thinking on the part of patients. Why are there none to label incorrect thinking on the part of the caregivers? The word “misdiagnosis” is too simple and innocent for it, but is there a code for that? There needs to be more sophisticated labels for the more sinister practices harming patients. Otherwise how will any of that be diagnosed so that it might be healed? Or so it at least will not continue to harm the patient?
What would be the correct diagnosis code to describe the originator of the falsehoods that were recorded to cover up the problem? What would be the one to describe all of the caregivers who uncritically fell in line with those lies and by so doing enforced that label as the only history on the matter?
How can you solve a problem that you cannot correctly diagnose and label?
A more Sinister Darkness
People who are victims of natural disasters, like hurricanes and earthquakes, usually escape having psychological baggage weigh them down for long afterwards. People who are victims of disasters caused by humans, like the Exxon Valdez, have a higher rate of mental trauma. But at least that was an accident.
People who are victims of injuries incurred in medicine suffer more. Especially when the injuries were caused intentionally. And is there any other way to describe the injuries caused by not getting care for the original injuries when health care professionals will not diagnose let alone treat them?
Treating patients as though they are the enemy
What do we call the injuries caused by being surrounded by a community that is determined to make it appear as though the problem is the patient. That is the special form of mobbing and bullying reserved by the community of health care professionals for patents.
What would be the label for health care professionals conspiring to injure the victim in order to protect reputations and/or careers and/or their belief in their own malarkey?
Whatever the label, when patients cannot get even recognition of their injuries, let alone treatment, because caregivers have such a strong need to disbelieve in the injuries, and there is no place those patients can go to find an advocate who honestly has their interests at heart, is the situation that has been created for patients anything short of evil? That is commonly what happens to injured patients.
It is not uncommon for people never to recover from having a group of people singling them out for unjust, and sometimes life-ruining, treatment.
Do you think you can find anyone in medicine who even is aware of having done that? The mental gymnastics they do to arrange their beliefs in ways that leave themselves feeling righteous are disturbing to behold.
One of the ways they do this is with theories and learned articles about how to create a “culture of safety” or a “culture rich in reporting” or a “culture of respect” (for instance, this article by Leape). I’ve written more about that on this site at Silence VS Safety.
What medicine has is a “culture of collusion and cover-up” about which they are defensive, protective and in denial. It is one of the features of our health care system that is so firmly entrenched that it is not recognized. The beliefs, habits and self-interests that create it are the norm. They even write articles about how being less critical of the care of other physicians would be better for patients. And how forming “huddles” on a regular basis to create agreement on the “facts” will make medicine safer for patients, without any sense of the ways in which those practices can be used to do just the opposite in a world where providers stay focused on processes, instead of outcomes, and patients can get no reliable information that would enable them to be a check on the problems created.
Those are the only people to whom injured patients can turn for help.
Caregivers need only be on the same page.
Patients need mechanisms that can help them protect themselves when their caregivers turn on them.
Blacklisting is mischaracterized by the medical community in order to deny its existence in their own minds as well as in the public’s. They dismiss it as though blacklisting required a physical list being passed around. It can happen with no communication between physicians at all, as long as they are on the same page, as though they had a list.
Being surrounded by others who share your perspective is a powerful reinforcement
No one in medicine thinks that blacklisting is an issue. For them, it isn’t. It is not happening to them. So they never are going to pay attention to it, let alone fix it. If the well being of patients were their first priority, they would. But it’s not. And their perspective is too self-serving to see that. Injured patients need someone with a different perspective.
“Every doctor will allow a colleague to decimate a whole countryside sooner than violate the bond of professional etiquette by giving him away.” – George Bernard Shaw
It’s nothing new. Fortunately, it can become a thing of the past, if the patient community stops repeating what it always has done in the past, which mainly is imagine that health care professionals and/or the government can fix this for them.
All that is necessary for speech to be libel or slander or defamation is for one party to say something untrue to another party and have that second party believe it. It does not have to be widely broadcast. When the health care professional who injured the patient tells lies about the patient to other health care professionals in order to protect him or herself, why is there never a suit brought for defamation? It can cause additional physical injuries when patients cannot get treatment for the original injuries (see a case where a patient did, on another site, when it didn’t even cause injuries).