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Blacklisting Patients

Expectations influence perception.

Physicians assume a basic level of honesty from their peers. They do not anticipate sins like rape from colleagues and the deliberate obfuscation of such. So a patient arriving claiming to have been injured by another health care professional is regarded as a crazy person who potentially could ruin the career of an innocent colleague.

It really is just profiling patients

The Signal and the NoiseAs Nate Silver says, in the book at left, we unconsciously let biases based on expectation or self-interest affect our analysis.

When injured patients go to doctors for treatment for iatrogenic injuries,  the doctors do not believe what the patients say and so do not waste time making records of it. They don't write down what doesn't make sense to them. If the patient says he/she was injured on an operating table, the doctor is not likely to believe it. No record is likely to be made of the claim (perhaps especially if the doctor believes 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.

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 is what gets written in the record.

Living in a fictitious world built on a denial of facts.

How subjective minds interpret the evidence of their sensesIf 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 the doctor seeing, say, a rape victim, 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 serial killer health, and care professionals are asked why they don't report caregivers who are murdering patients, sometimes they say 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.

Institutional Blindness

There also can be 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, medicine tends to be so defensive that what is common is for patients not even to get that. Patients seeking only medical help are asked how they got injured and, if they answer that question, cannot get even a diagnosis, let along treatment. 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.

C43.4

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, 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.

Caregivers 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 (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.

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 records and practices harming patients. Otherwise how will any of it be corrected?

Misdiagnosis Codes

There especially needs to be one to describe the originator of the falsehoods recorded and spread about the patient by the caregiver responsible for the injuries who now is trying to cover them up. There also needs to be 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.

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. What do we call the additional injuries caused to patients by their not being able to get treatment. Their conditions can deteriorate further when denied diagnosis and treatment. They are surrounded by a community that is determined to make it appear that 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 while believing in their own malarkey?

Somatoform Diagnosis?

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 spiritually 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.

Culture

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 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.

More on Blacklisting->

 

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