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Full Table of Contents
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Abbreviated
Table of Contents
Home Page
Patient Safety
Silence vs
Safety
Silenced
White wall
of Silence
Silencing
Conflict Of
Interest
Psychology of
Providers
Subjectivity
Blacklisting
Nurse survey
Loyalty
Mobbing and
bullying
Trust Us
Defensive
documenting
Report Rate
Risk
managemnt
SOAP
Management
Hospitals
Crime in
medicine
Sexual Abuse
Liability
Limitations
Free Speech
for Patients
Exploitation
OSMB Medical
Boards
Mammography
solutions
Medical errors
Medical Complaints
One number
Links
Injured patients who want to help and be heard,
click here.
Thomas Jefferson said that given the choice between
government without newspapers and newspapers without government, he would choose
newspapers.
In medicine we have government without newspapers. Patients
cannot find out what they need to know to make informed choices. No one in
medicine records or reports the information patients need to know the most. So
patients will have to do it.
| | Crime in Medicine
When our systems fail to acknowledge the problem of
intentional harm, let alone do anything about it, they are not systems adequate
to policing less sinister problems. If medicine really was
interested in the well being of patients, they would understand that this is the
first and most basic problem in patient safety. But they don't.
When you mention the crime rate in medicine, healthcare
professionals
brush it off as being too rare to bother with. Would we accept it from the police if they brushed
off
rape on the street because of its rareness? Or any other crime outside of
medicine?
The Routine Activity Theory of crime is one that should be discussable with regard to crimes committed against patients since it emphasizes situational factors which give rise to criminal opportunity rather than blaming individuals. That fits in with the current vogue in patient safety discussions
that blame systems or institutions or environments or anything other than the people who commit the crimes.
All the way back to Thomas Hobbes it has been recognized that no matter how pure or "good" someone was, he or she still could be a violent, selfish human being. But currently, in spite of all testimony and statistics to verify that surgeons and
nurses commit criminal acts against patients, the subject is treated as though it
is not worthy of discussion [for instance the line often repeated by patient
safety advocates, "we don't believe people go to work to to a bad job"], so lets just deal with Routine Activity Theory of Crime.
Any patient safety effort that does not begin
by addressing the problem of crime against patients
ignores the fundamental problems
Routine Activity Theory says that crimes occur when three conditions are present:
1) a suitable target is available
2) there is no guardian to prevent the crime
3) a likely and motivated offender is present
1) Patients are easy targets. They are trusting and nearly helpless, like children, and have almost no ability to respond to crimes committed against them. They don't know how to respond or who to turn to to find out. There is no number to call to get an advocate. If you think the victim can get help by calling a
lawyer, first read elsewhere on this site about how unlikely it is for victims to get lawyers. (Do we want lawsuits to be the only option anyway?) If you think the police or state medical board will be an advocate, read elsewhere on this site about that too. Injured patients, as a rule, have no advocate.
2) Healthcare workers virtually never report each other, which means there is no guardian. This is one of the chief components creating the climate in which it is possible to get away with so much in medicine. When a patient has a problem, people in medicine unite against that patient. They protect each other, not
patients who are victims. The only forthcoming witness will be the patient and there is no one for that patient to
tell. If the patient tells the wrong person, the patient can be sued. We know of
risk management departments who persuade patients they can be sued even for
going to the police. 3) It is not uncommon for someone in medicine to want to do something he or she shouldn't.
There are statistics on how often crimes are committed by healthcare workers
against patients, but medicine chooses to ignore them.
I'm not sure anything can be done to make it so that patients are not easy targets.
But something needs to be done to provide guardians for patients and a system that will respond to it when patients report having been victimized. Other
healthcare workers never will do this job. They even are in denial about its needing to be done.
So is the society as a whole. One lawyer, speaking about a doctor who had intentionally disabled a patient,
brushed if off by saying to me that he is sure that the surgeon does a lot more good than harm. I could write a book on my problems with that statement. But I'll just quote someone else
dealing with one aspect with what is wrong with it. Henry Pontell, a professor of
Criminology and author of books about white collar crime, said that someone with the highest pedigree intentionally hurting people is a lot more damaging to our social structure and our institutions than the actions of a common criminal.
Think of how corrosive it is to civility and faith in our institutions and the
willingness of people to function within normal decorum. Beyond that think of
how the injury radiates out. Remember the point of the movie It's a Wonderful Life with Jimmy Stewart?
The angel shows him all the good that would not have been done if Jimmy Stewart hadn't lived to help all those people.
If Jimmy Stewart had been a patient who was disabled intentionally he would not
have done all that good. When measuring how much damage is done by a healthcare worker who sins against patients versus how much good that healthcare worker has done, you have to measure all the good that would have been done by
patients but wasn't when their lives came to be about surviving the injuries, rather than about going out into the world to do good work
that helps others. Their families also do less good work as more of their time
and attention is absorbed by the injured family member. The damage committed by healthcare worker radiates out
to effect many people for a long time.
Besides, how do you measure the agony of a patient who no longer provides for his/her children, has a marriage fall
apart, and becomes a recluse after sins committed by a healthcare worker? How can
any amount of good done elsewhere make up for that? Especially when the sinner has multiple victims? All those considerations aside, it is not acceptable for the community to play judge and jury by making assumptions about whether or not the sinner should be
reported because rationalization like being sure the sinner must do more harm than good. When a crime is committed, the right, legal and moral thing to do is
bring it to the criminal justice system. Crimes committed in white collar settings, like hospitals and banks,
are not understood or appreciated. Actually, most white
collar crime is not one on one. It is not someone saying to a specific person, "I am going to harm you
specifically." Except in medicine where it often is. In medicine it often
is more like what a street thug does than most white collar crime. But in
medicine they have so many layers to hide behind - expensive lawyers, the ability to destroy evidence, loyal witnesses, the great facade,
etc. If you want to be evil, medicine is a good home for you.
Sex abuse of males
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