See also: Community Patient Agencies
Patients reporting problems are surprised to discover that the “appropriate” organizations to which they are supposed to complain are in the business of protecting and promoting the interests of the people about whom they are complaining. That patients are surprised to learn this is one of the reasons that this remains a problem. In what other realm of life are we naive enough to imagine that one advocate can represent the interests of both of the parties in conflict? When things go wrong in medicine, medicine divorces you. In a divorce, can your spouse’s lawyer, who is also his/her best friend, represent your interests too, or do you need your own lawyer? This is one of the many ways in which thinking about medicine is constrained by precepts inherited from the self-interested perspective of medicine. Even patient safety advocates blindly fall in line with it when they dream up ways that they imagine will make it so that medical boards will represent both parties at the same time. No matter what their mission statements say and no matter what the directors of them want everyone to believe, the primary agenda of a State Medical Board is to advocate for caregivers. They are run by and for caregivers. They do not know, let alone represent or protect, the interests of patients.
Can you dream up ways to make the Klu Klux Klan a worthy advocate for complaints about about hate speech?
If you think that statement is harsh, see OSMB on this site, a study of one year of the disciplinary actions of a state medical board. Or look at cases like Dr. Kashyap. The complaints of patients, even multiple patients complaining about one doctor, almost never result in action that would protect future patients. As George Bernard Shaw said in The Doctor’s Dilemma, “It may also be necessary to hang a man or pull down a house. But we take good care not to make the hangman and the housebreaker the judges of that.”
They don’t report Hodads And are not aware of what’s worse
Patients need an advocate on their side. Patients need a State Patients Board with the authority to accept any and all complaints about health care and, if nothing else, make sure they get to the right organizations and then follow up on them. In order to follow up, a State Patients Board must have the governmental authority to view any and all records that are held by and/or can be viewed by any of the other boards and organizations running medicine, especially the state medical board’s records.
If a patient complains about sex abuse, the State Patients Board must be able to see any and all other complaints that have been filed with other agencies or hospitals or clinics or anywhere else by previous patients so that some history can be learned about the caregiver in question. Otherwise there will continue to be problems like Kashyap and Schramm and Burt.
State medical boards routinely derail criminal investigations that should have been handled by the police. A State Patients Board can stop that and keep track of it when the police fail to keep track of the number of complaints being filed on a specific caregiver as well. It should not take 10 years and hundreds of victims before anything is done to protect patients from caregivers who cannot be trusted.
When there is a dragon eating the children on the playground, you have a right, even a duty, not just to speak in general about studies estimating the rate at which monsters in general consume a percentage of the children who play on playgrounds, but to point directly at the specific one and say, “That one, right there, eats children.” And then do what is necessary to protect children from that dragon. Unless the dragon has the initials M.D. after its name and then there is a powerful community stopping you and you can be sued just for pointing at it.
Tracking the Decision Making
All records need to be available to a State Patients Board also to make possible analyzing the processes of record keeping and of decision making. Who made the decisions that resulted in the problem. Who made the records and how reliable are they? Why is there no record of the injuries the patient is presenting? Why is there no record even in the charts of the string of physicians the patient has gone to in an attempt to get the injuries treated (a common experience with iatrogenic injuries, see Blacklisting)? Why did none of those physicians even make a record of what the patient said when asked how the injuries were incurred?
Beyond Filing Complaints
Patients need an agency run by people who will help them when things go wrong. The patient community needs advocates who will speak to the press about their interests. The patient community needs advocates who will speak to local governments when medical interests are persuading government officials of things like the idea that it would be in the best interests of patients, and that it would lower the cost of health care, if patients had even less recourse when sins and crimes and errors committed in medicine ruin their lives. Did anyone suggest to any government official that it might do more good to give liability limitations to patients? Did anyone bring up that the 14th Amendment guarantees equal protection and that if they are giving liability limitations to caregivers they at least should give them to patients at the same time? No one heard those arguments because there is no one representing patients.
Career Patient Advocates
There needs to be someone our state and federal representatives can call to get help for a patient, or to get an official statement on the position of the patient community on an issue. They can get that for doctors and dentists and hospitals and nurses and everyone but patients. There needs to be someone journalists can call for the same information about patients. There needs to be someone a patient can call to get the kind of helpful information doctors can get by calling state medical boards. For patients that would be information like how to get a hospital to reveal who the patient’s caregivers were. Or how to get an iatrogenic injury diagnosed, the main thing they call me desperately trying to find out. For there to be people in an official capacity helping and speaking for patients, there needs to be a career path for them. There needs to be entry level jobs available for them and opportunities to advance to better jobs at places like State Patients Boards and community patient agencies. When that exists universities will tailor degree programs to prepare graduates for those jobs. The patient community needs this in part because currently agencies like the Department of Health and Human Services are not able to find employees who understand how to advocate for patients. The pool of available employees comes from medicine. And medicine has a conflict of interest with patients. Government agencies end up being populated by people who represent the interests of health care professionals against patients. Patients need people in those positions who understand the interests of patients. Currently people who get hired to be patient advocates are screened by health care professionals to make sure they are on the same page as health care professionals. That’s the opposite of representing patients. They don’t know what the issues are for patients. For instance, hospitals are required to identify a patient’s caregivers to the patient. But there is no one in charge of making sure that hospitals obey such regulations and there is no penalty for violating them. So when hospitals don’t want to obey them, they just don’t.
Out of Touch
When told about this, in my experience health care professionals usually respond by saying, “Call a lawyer,” which shows how out of touch they are. Patients almost never can get one. Health care professionals can, but patients cannot. And there is no agency that will explain to a patient how to file a John Doe suit to compel the hospital to respond to a subpoena to force them to reveal who the patient’s caregivers were. Medicine does not know how out of touch they are. As of this writing, I’ve never met a health care professional who could give a sensible answer to this question.
What is the least that a patient should be able to expect in medicine, the absolute least?
As far as I have been able to determine, the entire pool of people working as health care professionals knows only the answer that the care giving community is comfortable believing – an answer that can make you wonder if they heard the question. I’ve asked enough of them to be able to predict what they will say and write it down for them before they answer. Only an official governmental agency can do anything about the least that a patient should be able to expect, because the least is a policing function. And no one is doing it.
Some patient safety advocates suggest that there are things we can do to make patients safer without focusing on the absolute least they should be able to expect, without going as far to establish an honest complaint process or an official advocate to help patients respond to problems like abuse and graft. That would be like looking at a community with no police that has thieves and rapists freely marauding through it and suggesting establishing a Kiwanis Club because of all the good work those clubs do. For all the good work they do, they do not take care of the least that citizens should be able to expect – a just and civil community. Justice is not provided by civic organizations. Protection from crime is a police function. Vigilantes can do only so much. And local police departments characteristically will not let patients file criminal complaints against caregivers (see Crime in Medicine or, for an example, see Kashyap, both on this site). In medicine, the mechanisms that can address the worst problems are the same ones that can address the more modest ones. As long as there are no mechanisms to address abuse and graft and unfriendly practices, there will be no substantial improvement in the rest. How can there be when they won’t report them and they don’t believe in them and they dismiss them as being “another matter entirely” and not relevant to patient safety initiatives? Health care professionals have to “be there for the next patient.” Any time there is reason to believe that protecting his/her reputation, career, finances, etc, possibly could require it, any health care professional will behave badly and rationalize it as not being bad. At those moment it is not just that they decide not to accurately enter information in the record, it is that they interpret the evidence of their senses differently than an objective third party would. They don’t see what needs to be reported in the record. They see the evidence of their senses through very thick filters and create a record that maintains a status quo that is comfortable for them without recognizing when it is ruinous for patients.
The Status Quo is Unacceptable
Patient safety mechanisms, first and foremost, must be established to address that which no caregivers want to have addressed – dishonest and antisocial behavior. Mechanisms that are not so established address almost nothing, because dishonest and antisocial behavior is involved in most of the problems in medicine just by the meer fact of what is done to cover up the problems. 93% of adverse events are not put in the record at all (see Medical Reporting on this site). That by itself is dishonest and antisocial behavior. One need only examine the history of patient safety efforts over the last decade to see the trail of efforts that, in the eyes of health care professionals “made everything much better” as they continually tell us, but that in fact did nothing to improve the numbers of patients unnecessarily killed or disabled or bankrupted. They put varnish on rotten wood and, from their perspective, everything looks much better.
Since health care professionals almost never report problems or abuses, it is especially important for patients to do it for each other. There needs to be one phone number for all complaints related to health care. It needs to be answered by people who are on the side of patients. And those people need to be working at an official agency, with governmental authority, that advertises that it wants to hear your complaints. State medical boards do not go out looking for problems (see Schramm, a page on this site). Someone who understands the interests of patients needs to. Patients need an agency that looks for problems. That is the last thing medicine wants. If medicine really did put the interests of patients ahead of its own, there already would be one number. Public schools are alerted if a school employee commits a crime. That employee immediately is removed from having contact with children. State medical boards do no such monitoring of health care professionals. Health care professionals with criminal records related to trafficing in controlled substances are allowed to continue to dispense narcotics to addicts because no one checks to see if they have criminal records. Schools check their janitorial staffs better than that.
The public will not use a system that it does not believe to be responsive or fair. The average conclusion of patients who complain to agencies that are run by health care professionals, like state medical boards, is that they are neither. Discovering that discourages patients from even attempting to meet the onerous obligations required for filing complaints with them (see complaints). Complaint process are made that onerous when no one wants to hear the complaints. There needs to be a phone number answered by people who want to, people who can explain which agency, which department, which person, and whatever else you need to know to respond to what has been done to you, or who can at least tell you when there is no appropriate number to call. There needs to be one phone number that is answered not just by people who gain our trust, but who we actually can trust to understand our interests and to be on our side. State medical boards don’t even make themselves well enough known for patients to to be able to figure out who to contact.
Are they hiding?
What number do you call if the problem is with a pharmacist? Or a nurse? Or an anesthesiologist? Or a dentist? Why isn’t there, for all of it, a single phone number that rolls off your tongue right now as you read this? Because that is not in the interests of providers. It only is in the interest of patients. It is in the interest of providers to discourage reporting, which becomes clear to anyone trying to get anything done about injuries incurred in medicine. The kind of information gotten from such a phone number would be only a small part of the information that the patient community needs, but an important part. The patient community needs a much wider perspective, including deep data mining, in order to understand enough to make intelligent decisions, but for more about that read about Community Patient Agencies.
Just Getting Help
The first order of business for a State Patients Board would be to help the patient try to get care for the injuries, but the second would be to shine a light into the corners where the patient was prevented from getting such care in the first place. It is important to expose as much about the inner workings of the medical industry as possible, in part so that the people within it finally gain a more realistic understanding themselves. But also so that the government and the patient community can understand it.
The agencies currently in charge never have done these things for patients and they never will. They are run by the wrong people.
Currently complaints can be filed only with people who are not on the side of patients. Just as there is no one a journalist can call to get the perspective of patients on an issue and no one a politician can call to get help for a patient, there is no one patients can call either. Hospitals have guilds and associations. So do anesthesiologists and radiologists. State medical boards lobby state governments to promote the interests of caregivers. The AMA lobbies the federal government in the interests of medicine. Pharmaceutical companies are legendary for their lobbyists. Where are the advocates for patients?
There are none.
Did you ever file a medical complaint? What happened as a result? Nothing, right? Patients have no advocates. They have no agencies on their side. State medical boards say that behind closed doors they take care of the problems patients report to them. Behind closed doors? Justice does not exist behind closed doors no matter who is in charge, but that is where medical complaints go. You cannot even find out what was done with your own complaint because it is kept secret behind closed doors. Patients need to have their own advocate with a foot in that door watching what happens to their complaints and standing up for them.
There is money earmarked specifically for projects that can help solve this problem. Applying for that could be the first step. Working on this doesn’t necessarily require getting thousands of random people to agree to something. Three of the right people in one state could show the rest of the country the way. More thoughts on that can be seen at Campaign by clicking Next.
State Medical Boards
It is as though we are the founding fathers and we have established only the executive branch with no checks and balances. No legislature and no Courts. Just a president. And the complaints and discussion are about how to make the president take better care of us when what we need is to establish a body to represent us. That is what we are doing when we complain about medical boards, the AMA, hospital complaint departments, and all the rest of the agencies representing medicine. They are not philosopher kings with no self-interest and the wisdom of saints. They are doing their job. But they are Dracula and patients are the blood bank. You cannot expect Dracula to become a better manager of the blood bank. All people believe they are well meaning and objective. But no people are. No people can represent both sides of an issue. If they could kings would be better than democracies with checks and balances. We need checks and balances in medicine. The state medical board is doing what it is supposed to do to issue and regulate licenses. A medical board investigator told one injured patient that the board’s job was to keep doctors working. One injured patient was told by the medical board investigator on her case that job of the board was to keep doctor’s working. It is ignorant to think there is some point in complaining about their not being saints and representing patients at the same time.
We need representatives advocating for patients to make up for the fact that health care professionals are self-interest humans first and caregivers second. We need state patients boards to be a check on the authority of state medical boards. And we need community patient agencies to provide a source of information that does not come from the medical industry, which is necessary to balance the power of the hospitals and clinics and pharmacies and physicians’ offices. The next time you hear someone complaining about state medical boards not doing their job, the only thing you need to say is that their job is to advocate for care givers and they are doing that job. They only are humans and cannot be expected to represent both health care professionals and patients at the same time. Patients need their own representatives. Patients need a State Patients Board and a Community Patient Agency.
For thoughts on how to establish such boards and agencies, see Campaign by clicking Next.
Below here is a note toward future paragraphs, possibly for a different page: Wal-Mart Stores Inc., the nation’s largest employer, began moving into medical tourism in 2013 (reported off-site at this link) by offering insured employees no-cost heart and spine surgeries at chosen hospitals across the country. They even said they were going to pay the travel expenses. Under special arrangement, the cost of a treatment will be bundled so that all the caregivers involved in a case share a lump-sum payment rather than billing separately for tests, procedures, hospital stays, meals and so on. Wal-Mart knows how to do business and knows that understanding costs up front is fundamental to honest business practices – something that medicine routinely rationalizes as not applying to itself. What patient is able to get an understanding medical costs up front, or even after the fact much of the time, as surprise bills keep coming in? A Community Patient Agency could help with that by keeping track of what things have cost other patients and making that information available to patients ahead of time.
William Makepeace Thackeray wrote of people with “no particular objection to vice, but an insuperable repugnance to hearing vice called by its proper name,” an accurate description of the response of health care professionals to these issues when stated from the perspective of patients.