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Patient Driven Medicine

Eat, think, and be wary

by Joel

A story in the New York Times about lax infection control in military hospitals and a whistleblower whose career is ruined in order to send a message to other whistleblowers is a clear example of the nonsensical way we think about medicine. The article says that at any hospital patient safety depends on the willingness of medical workers to identify problems.

Your well-being depends more on the beliefs and interests of health care workers than on knowledge of your own? Why do you tolerate that for another single day?

This can be reversed. The patient community has the ability to gather the information necessary to know better than to let their doctors send them into death traps, like hospitals with lax infection control.

It is time for this paradigm shift in thinking about medicine that will make it safer, more effective and more affordable. Medicine won't protect patients until patients know when they don'tIt is time to stop imagining patients should trust health care workers about whom they know nothing beyond their bedside manner.

It is time to stop trying to micromanage and "fix" medicine like we have been trying to do for at least 160 years.

If it were possible to "fix" medicine, we would have gotten them to start washing their hands enough more than a century ago. No one ever has managed to get them to comply enough even with mere hand hygiene requirements. What we have to do is make it so that patient know when they don't. Then the well-being of patients will not depend on health care workers finally doing what they never have done before, but instead will depend on the patient community finding out where patients are safe and well and where they are not.

Most of this site covers the problems. The rest is about how to accomplish the above. I wish that solutions were the only thing posted here, but gaining insight does not spring merely from new thoughts. It requires understanding how the ones are holding us back. Otherwise we keep them in order to keep the peace with those committed to maintaining their comfortable status quo and they defeat us.

Solutions ..........|.......... Problems
|
......................... | ............ Myth #1
|
Patient Agency... | .........................
|
Nequamitis ....... | ........................
|
......................... | Conflict/Interest
|
........................ | ............. Loyalty
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......................... | ..Wall of Silence
|
.................. ...... | .......Blacklisting
|
........................ | ....Psych of Care
|
........................ | ... Transparency
|
........................ | .. Charles Cullen
|
........................ | Orville L Majors
|
........................ | ......... Kayshyap
|
........................ | .............. OSMB
|
........................ | ..... Semmelweis
|
........................ | . Benjamin Rush
|
Patients Boards. | ........................
|
Campaign ... | ..................

"If we can get just 10% of people to be smart patients, it will change the system." - Mehmet Oz, surgery professor.

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Patient Driven Medicine Versus
The Benevolent Overlord Model

Put ten doctors in a room to talk about patient safety and what do they come up with? In the last couple of decades they came up with the liability limitations for themselves that increase their position as the overlords of powerless patients.

Is anyone working on a plan that does not further entrench us in that paradigm? All of the talk about Patient Centered Medicine only further entrenches us in that model.

For instance Transparency - the thing benevolent overlords are supposed to provide in spite of their conflicts of interest and the self serving lens through which they see the world - keeps all of the information about medicine in their hands.

When medicine makes patients better it is advertised. When it makes them worse 93% of the time no record is made of it at all. That is what overlords do when they are not benevolent.

Neither providers nor patients can make informed decisions without knowing what providers never have and never will report.

Ludwik Fleck, a physician, said that "to see" means to recreate a picture created by the mental collective to which one belongs. This is true of the caregiving community. For instance, it sees itself surrounded by frivolous suits rather than patients it has injured. And it sees as good for patients treatments that are good for itself no matter how bad they may be for patients (examples are on the site).

For patients to survive in spite of this requires information about medicine that has not been filtered through the self-interested mindset of the medical community.

Objective information is the foundation for reducing the unacceptable rates at which medicine bankrupts, injures and kills patients. Patients must be able to learn where safety, efficacy and affordability lie. Doctors do not steer the patient community around even untrustworthy caregivers and facilities, let alone around the incompetent and/or outrageously expensive. They never will. This is a job the patient community will have to do.

Neither providers nor patients can make informed decisions without knowing what providers never have and never will report. Health Care Professionals do not have the objectivity necessary even to recognize such information. The information necessary to make safe decisions can be collected only by people who are not in the employ of medicine.

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Loyalty is the core operating ethic of medicine, not integrity, and not safety. When things go wrong, disloyalty is what ends careers. Failing or refusing to report problems does not end careers. Failing or refusing to help patients does not end careers. But being disloyal to colleagues does. And loyalty is maintained through self-serving delusion, denial and silence about the people and problems harming patients.