Once someone becomes a health care professional, that person never again can experience the world of medicine that patients experience. They have the means to avoid experiencing it themselves and the protocols and mechanisms for managing, if not destroying, information that could enable awareness of uncomfortable truths about it. When things appear to be smooth and happy in medicine, as easily as not that can mean nothing more than that their machinery is operating in the self-serving way that keeps them oblivious to the kind of world they make for their patients.

Often doctors describe the world in terms that assume that they have a clear, objective view of medicine while all others, especially patients, are on the outside trying to look in through a smudged window. There is little appreciation for how much the vested interests of people who earn their livings in medicine can make them more subjective than anyone else, or the extent to which people personally experiencing the result of their care can be more objective on important points.

For instance, when a patient becomes a victim of an error or a sin in medicine, the first thing medicine does is create a wall around that patient. It doesn’t put a window in that wall through which it can peer at the situation inside. It doesn’t want to see. It doesn’t want to know. It doesn’t want to understand. It doesn’t want to admit how much damage it has done and how much more it causes as it protects itself under the “You have to protect yourself from lawsuits” clause, and the “You can’t let one patient ruin your whole career” clause, either of which, in practice, override “First do no harm.”

As more and more harm is done to the patient who needs help but can’t get it, caregivers decide and collectively believe that the complaints of the injured patient either are frivolous or are problems that could interfere with their “being there for the next patient.” The medical community routinely shuns any caregivers who create diagnoses of iatrogenic injuries. Being shunned could interfere with a caregiver’s ability to be there for the next patient. So “do no harm” is applied to the community of patients by harming individuals in order to protect themselves, as though they were quarentining someone with a communicable disease. And they manage to do this without ever seeing that it is they themselves who are the problem, not the injured patient.

In their world every patient with iatrogenic injuries must be dismissed and forgotten with no record made in order to comply with the requirements of the community of caregivers that no blame and no information accrue from its sins and errors. And while doing that caregivers manage to imagine that they are doing what is best for the community of patients. If they had accurate information about how many patients get injured, it might be more difficult to dismiss a community as large as the group of patients who have been injured. But that is part of what they do not want to know and do not want to understand.

Have you read the nurse’s emails sent to me to defend their handling of Orville Lynn Majors as he was murdering patients? She sees it through medicine’s self-serving lens that makes seem reasonable statements like, “Millions of patients go to medicine without getting injured” as a justification for not reporting a serial killer or trying to protect future patients from the murderer. If she had she could have lost her job.

Inside medicine that is more important than the well-being of any number of patients.

Outside of medicine, we think a career is not as important as a life, perhaps particularly when the pupose of the career is to save lives.

It is like lifeguards at a beach saving only those who are acceptable to the community of lifeguards because otherwise those other lifeguards would not help them save the next victim. And then rationalizing that it is doing what is best for the community of swimmers by letting the unacceptable ones drown. Except that lifeguards would not be the ones who caused the swimmers to drown in the first place. And they would have a harder time remaining oblivious to the fact that they were causing people to drown and then making sure that no one saved them.