What happens to the wounded shark?

In a series of four articles entitled The Cost of Courage: How the tables turn on doctors, Steve Twedt of the Pittsburgh Post-Gazette has highlighted a growing problem faced by doctors who choose to go to bat for better patient care.  All over the country, doctors who point out unsafe conditions in a hospital, or substandard work by colleagues, are being targeted for retribution.  Many of these physicians are being terminated or disciplined on the grounds that they are being "disruptive." They are shunned by their colleagues, their reputations smeared, and often they find themselves listed in the National Practitioner Data Bank (since being a "disruptive" physician gets you on the list) - a move that makes it very difficult for them to find work practicing medicine anywhere in the U.S.  It is the medical equivalent of the NCAA "death penalty."

Hospitals can discipline "disruptive" doctors with relative impunity, as the courts have taken pains to avoid getting involved in hospital politics. Thus, due process is routinely denied to the whistleblowers being accused of disruptive behavior, and they are punished and branded with the scarlet D without a fair hearing - and certainly without anybody addressing the safety complaints that got them into hot water in the first place.

Twedt's series, which describes in detail the amazing cases of many individual doctors whose careers have been left in tatters because they tried to speak up for the safety of patients, can be found on-line here.  DrRich highly recommends it.

DrRich Comments:

The whole point of this website has been to demonstrate how the covert rationing of health care necessarily leads to destruction of the doctor-patient relationship.  Rationing covertly means rationing at the bedside.  So, to ration covertly, doctors MUST be coerced not to give priority their patients' best interests.  Instead, doctors are forced to bend to the the interests of the people who determine their viability as practitioners - the folks who cut the checks.  Accordingly, my illustrations of covert rationing have centered on the coercive policies of either the feds or the health plans, and have described in detail the lengths to which these payers will go to keep doctors in the fold.

Mr. Twedt points out a whole new level of coercion, one that, if anything, may be even more malignant and determined.  This coercion is promulgated by the very people and institutions whose reason for existence is to provide care to sick people - doctors and hospitals.  When a doctor displeases a health plan, the worst that can happen is that the doctor will be dropped from the health plan's physician panel.  When a doctor crosses the feds, the penalty is rarely worse than a huge fine (though years of blood, sweat, and tears may be expended defending oneself from worse.)  But when a doctor runs afoul of his own colleagues or trips over the tender mercies of a hospital, he is treated with the sort of compassion displayed by a school of sharks when one of their number is wounded.  He is as good as dead, professionally speaking.

Why is this?  It's simple human nature.  Once a person under duress gives in to the forces of evil, nothing is more threatening than the appearance of one who will stand up to and challenge that evil.  Such a one threatens the very soul, and must be eliminated without mercy.  Think of the viciousness of the Vichy government during the Nazi occupation.  And while all overseers in the time of slavery tended toward nastiness, most reports indicate that the most brutal were themselves fellow slaves.  Once you decide to coexist with evil, even if it feels like the only option you have, the last thing you need is for somebody to start shouting about how you're evil too. 

Hospitals, and the doctors who work in them, have had to resign themselves to rationing health care covertly.  They need to maintain the fiction that all they are doing is for the best interest of patients, while in fact, merely in order to survive they need to place the bottom line first.  It is easy to rationalize this action; it is easy to convince oneself that it is absolutely necessary.  For, if they do not put the needs of their patients behind financial concerns, they truly will go out of business - then how well will the patients fare? So the only answer is to place the bottom line first, then do what you can for the patients under these constraints. There's no choice.

So now comes along some cowboy who just doesn't get it.  He starts complaining - publicly, for God's sake! - about nurse-to-patient ratios, or an inefficient system for administering drugs, or some doc who's doing twice the number of cardiac catheterizations (a procedure that still pays very well - we don't ration things that make us a profit) he ought to be doing.  The mere fact that he's bringing this up means he is beyond reason, hopeless.  He's a traitor, and treason is the one crime that everyone agrees deserves the death penalty.

To see just how real this all is, please have a look at Mr. Twedt's series of articles.  His stories nicely illustrate another powerful reason why covert rationing is poisonous to our society.

November, 2003

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