Dr. Spyros Panos
Unfriendly practices with cooperation
It should not take 5 years and hundreds, if not thousands, of victims for someone finally to do something to protect patients. Even when the problem is as bad and as blatant as the unfriendly practices of Dr. Spyro Panos the people in charge are not interested enough in the well-being of patients to protect them from it.
Even after all we now know, not all patients have been protected from him - only patients in New York. There is nothing stopping Panos from practicing in other states. He still has a license to practice medicine in Virginia (as of 2013).
Health care professionals will dismiss this as a one-off, as a rarity, and as something that now has been handled. They will not view it as symptomatic of a pervasive problem.
There really needs to be someone on the side of patients
Between 2007 and 2011 250 patients in New York filed suits against Dr. Spyros Panos for performing botched or unnecessary surgeries, or billing for surgeries that he never performed. When you consider the fact that of the patients with legitimate grievances, only one in some thousands can get a lawyer (see Studdert), how many patients must have had legitimate grievances for 250 of them to have gotten lawyers?
According to statistics from the American Academy of Orthopaedic Surgeons, a typical orthopedic surgeon schedules a maximum of 32 procedures a month. Panos scheduled as many as 22 in a single day. Someone actually working for patients, like say in a Community Patient Agency, would see that and put a red flag by his name, just as someone in such an agency would see how frequently the patients of Orville Lynn Majors died and put a red flag by his name in order to protect patients. But that is not what they do in medicine. In medicine they protect their reputations and their careers.
Silence is Complicity
Silence is the norm in medicine. "You can't perform this many suspect surgeries without the cooperation of many other people," said Arthur Caplin, the director of medical ethics at NYU Langone Medical Center. Medicine is a team of people who are loyal to their team. They cooperate.
Like the case in Canada in which 21 women have accused Dr. George Doodnaught of sexually assaulting them while they were under conscious sedation in the operating room (according to The Canadian Press). His lawyer said to the press that it would be impossible for him to have assaulted patients undetected. Does he think it also would be impossible for a doctor to pretend to do surgeries that he didn't do without being detected? And to do botched surgeries undetected? Dr. James Burt did, but that is not the point. Orville Lynn Majors murdered patients on a ward where nurses were betting on who would die next on his watch without their doing anything to stop him. If they hadn't detected him would they have been able to bet on him?
Detection is not the point
The point is that in medicine it doesn't matter if you are detected. Nurses and doctors testify for such people, not against them, whether they detect these problems or not. You fight for your team. In medicine if you don't you never get to play on a team again (see Loyalty).
Even without that fact, medicine energetically and systematically works not to detect whatever it can avoid detecting, in other words, to know as little as possible. For instance, see the case of Charles Cullen, a health care professional serial killer. Can the record be wiped that clean without their knowing that there is something that needs to be wiped clean?
Things do not merely go undetected in medicine. Things are made undetectable. Panos doing as many as 22 surgeries per day did not raise red flags among the staff and administrators?
What do they detect?
Patients think that someone is watching to make sure that health care professionals are competent and compassionate. In fact, no one is watching even to make sure that they are not thieves or under the influence (see Malakoff, the vice presidents doctor) or just plain dangerous, or even murderous, let alone competently curing patients.
Checks and Balances
Fixing this is not a matter of educating or re-educating caregivers or tweaking their system or fixing their culture. It is a matter of recognizing their their conflict of interest and creating the means to counter it. Patients need to do this. The caregivers everyone expects to take care of this are the wrong people with the wrong motivations. Asking people in medicine to police themselves is not providing a check or a balance. Everyone has so much faith in caregivers to be saints when they should have skepticism. There needs to be someone outside of medicine working on the side of patients. No one working in medicine ever can be on the side of patients in the way patients need them to be. Just look at the cases of Panos and Cullen and Majors.