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It's a path

Citizen's Oversight

At one time I proposed patients joining together to form groups to accomplish what I now believe can be appropriately addressed only by official state agencies like State Patients Boards. However, this page is left here for some of the thoughts on it.

Doctors want outside oversight of those who provide to them
but find it unreasonable when patients want oversight of doctors.

The desensitized personal consciences of doctors are supposed to be replaced by "institutional consciences."

Doctors cope by manufacturing a professional distance between themselves and the disasters they face. To become a good doctor requires a certain amount of depersonalization, coming to regard people as objects rather than humans. But turning off passion is not just a coping mechanism, it also is a rule governing how they are supposed to behave.

A doctor is supposed to treat the patient in front of him or herself, period. Inclination and moral judgment are not supposed to interfere with their work. Whether it is dissecting a disgusting cadaver in medical school or treating the apprehended pedophile for AIDs, they are trained and hardened to be amoral pragmatists. If you were looking for the worst way to produce moral leaders, medical training might be it.* And yet who is in charge of the medical boards that are supposed to bring conscience to healthcare? Doctors.

To police this constituency, we appoint members of the same constituency. Appointing hospital administrators is unlikely to be more practical. They already manage organizations that do not find or report problems. Perhaps a few injured patients should be appointed.

Without clear definitions of the limits of their authority and options, doctors are dangerous.

The laws governing jury trials do not mandate that juries be composed of doctors even if the crime is medical. We look to juries composed of regular citizens to make grand, life-altering, precedent-establishing decisions about right and wrong. In the end a state medical board is the judge and jury. Why are their boards composed almost entirely of doctors?

People who have hardened their consciences in order to carry out specialized tasks are the wrong people for making moral decisions no matter how eloquent and authoritative they appear and believe themselves to be. Certainly a state medical board would want doctors and nurses available to explain issues, but to have them also be judge and jury is folly. Institutions governed by doctors are too sympathetic to doctors and too desensitized to patients.

The OSMB fails to provide the institutional conscience necessary to protect patients.

Beyond the issues of sympathy and desensitization is the issue of managing a bureaucracy. MDs are not MBAs. Below the board of directors of a state medical board is an organization that needs to be directed. People in business get advanced degrees in management and spend years on the job learning to be managers. That's not what doctors do.

The theory might be that there are career civil servants employed to handle management, but the unique nature of the privacy laws hiding what they are doing renders them civil servants who are accountable to no one. If there are any questions about how bad an idea that is, compare their disciplinary actions to the complaints they receive. The board of directors serves more as judge and jury than as overseers of a bureaucracy. The bureaucracy is left alone behind closed doors. No matter how well meaning they might be, that is a bad idea.

The laws governing the composition of state medical boards, and the great influence of medicine, leave little hope for meaningful improvement in the current way of doing things. They can pass new rules and reorganize all they want. They've done that in the past without producing results that are any different. It still will be an organization that lobbies the state government to pass laws against patients, rather than an organization the really is on the side of patients.

Below I suggest forming a citizen's watch dog group to monitor it, but I am not sure how much good that actually will do. It might be worth exploring, and so I contribute some thoughts about it here, but what is needed first is simply a phone number, one single phone number that can be called with all complaints about healthcare, and that I've written more about at this link. There needs to be someone at that number who can tell patients how to get a hospital to cough up documents, and what to say to the police when they say to call the state medical board, and myriad other things no one currently tells injured patients.

Thoughts toward the creation of a citizen's group

The public will not use a system that is not believed to be responsive or fair. Many come to the conclusion that the state medical board is not responsive or fair before they even receive the complaint form in the mail. Just on the basis of interacting with the state medical board on the phone, they already are discouraged enough to resign themselves to suffering negligence and abuse with no hope for protection or justice. I have brought this up with the state medical board and suggested monitoring the phones to find out how many people telephone, but then give up without going any further. They were not interested in finding that out.

This is one of the many things that would have to be discovered by an outside group. If nothing else, or perhaps as a first step, a Citizen's Group could propose studies that need to be done and then look for funding for those studies. Other organizations and universities could do them. Studies should be about everything from finding what percentage of people know that a medical board exists, to tracking cases to find what kinds of sins never are punished and why, to monitoring their phones to learn how to improve the means of access for the help-seeking public.

However, I have come to the conclusion that what we most probably would learn in the end is that the real business of protecting patients unlikely ever to be able to be conducted by a licensing agency. It will have to come from somewhere else with the state medical board merely responding by revoking licenses from time to time, which is the way it already operates. 

Below are some thoughts I had a few years ago when I was suggesting things for discussion about how a citizen's oversight group might be used to help state medical boards protect patients. But as time goes on, the idea of "state medical board reform" seems naive. Their inertia always will be wrong for the job that needs to be done to protect patients. Currently they almost never discipline anyone unless some other agency finds the person guilty first. We perhaps would be better served to create an agency that either does investigations or at least makes sure that already existing agencies do not defer their investigations to state medical boards. Especially the police.

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The Ohio State Medical Board needs to become more consumer-friendly even if a referendum creating a State Patients Board is required to bring that about.

A routine auditing mechanism is needed to investigate the process by which the Board accepts and investigates complaints about medicine. The thoroughness and fairness of the process needs to be scrutinized and revealed to the Board itself if to no one else. Although it really should be made known to the public as well.

Since the talent, fairness, dedication, and flexibility of the participants in the process are more important than the system's processes, in the end someone outside of the Board will need the authority to direct or remove individuals who do not meet standards. From what we've been able to see so far it appears that some operators in this system are checking boxes on forms without making an honest effort to accomplish anything. If the Group, or an independent third party like the Citizen's Group, cannot either direct or remove such people, its effectiveness will be diminished.

The second thing needed is for someone like an oversight group to commandeer select cases, recruit outside investigatory help and come face to face with the same obstacles faced by the Board in order to gain perspective and learn lessons.

The third thing needed is the setting up of an appeals process by which the Citizen's Group or someone like it will review cases brought to it by patients who feel they were not dealt with justly by the Board. As far as we can tell (someone please let me know if I'm wrong) the Board handles such cases by running them through the same process they went through the first time.

Either there will be multiple institutions having authority
or there will be tyranny

One can anticipate many of the objections of the Board and Medicine itself to the idea of citizens studying and perhaps even overseeing this. Among the objections may be the notion that only doctors can understand medicine and only police can understand policing. But you don't have to have an M.D. to know when you're being raped. You don't have to have graduated from the police academy to know that failing to learn the identities of the nurses who witnessed a crime is not an adequate investigation. You don't have to have been raped to see that the Board never finds anyone guilty of things that, like rape, do not generate paperwork.

The Board is in dire need of auditing and oversight by people with a perspective different than that of the police and the physicians.

For more information about why oversight is needed, click OSMB
or consider the general history of all policing entities
operating behind closed doors

*Part of the definition of psychopath is an inability to feel normal emotions relating to the damage one does. To a certain degree it could be said that medical schools manufacture people like that. Of course, the detachment is necessary if they are to be able to do their work, but why is everyone surprised when some of them behave like psychopaths? And why do we not have structures erected to respond when they do?

Traits normally associated with psychopaths include being manipulative and grandiose, exhibiting a lack of empathy, refusing to accept responsibility for one's own actions, an inability to feel remorse, and relating to others on a superficial level. Aren't all of those on the checklist of the surgical personality?

See State Patients Boards