NOTE: Several family members were brutally slaughtered recently, so I will take a break from writing. Their deaths erased my affinity for writing about politics or the economy, thus I'll later limit myself to health and brainpower in addition to completing my book on rapidly overcoming racism and bigotry. BTW, the two men who murdered my father are still on the lam; I am offering up to $100,000 for information leading to their arrest and conviction.
Lie detectors for uncovering racism and sociopathy in healthcare providers
As I reported years ago, some racist healthcare providers intentionally murder patients they racially abhor, while others take advantage of patients in different abominable ways, such as by raping comatose women, especially beautiful ones.
That's the problem; what is the solution?
First, I think that every healthcare provider—from EMTs and paramedics to medical technicians, nurses, and doctors—should undergo training to eradicate racism and related ethical distortions that create a milieu for patient abuse. People in the United States are generally better at concealing racist feelings than eradicating them. Motivated by the desire to not be labeled as racist, people often bend over backwards to not reveal racist attitudes, but sweeping racism under the rug doesn't get rid of it: it just hides it from view. Other than shaming those labeled as racist, what has our culture done to fundamentally address the problem? I don't see any miracle cure, or even a passably effective remedy. I wrote my book on rapidly erasing racism and other forms of unjustifiable bias to address those festering problems.
However, my cure for racism is not effective in people, such as sociopaths, who lack empathy (learn how to spot a sociopath). Moreover, sociopaths often possess a charming veneer and an aptitude for deception that helps camouflage their mental warts. Thus, while I know my method of addressing racism is effective in people who care about others (that is, most people), it will not help the estimated 4+% of the population with sociopathy and related defects in conscience. Alarmingly, a study sponsored by the National Institute of Mental Health found the prevalence of antisocial personality disorder (sociopathy) “had nearly doubled among the young in America.”
While my antidote for racism and bias isn't effective in sociopaths, I think it may help prevent it in some cases, since evidence suggests that cultural influences affect the genesis of sociopathy. Getting people to read my book could be a problem, however, since the people most in need of it are the least likely to read it. In their (often twisted) minds, they don't have a problem, so why fix what ain't broken? This difficulty could be overcome by exposing everyone to it, thereby helping those with less extreme voids of empathy.
With prevention and treatment being the first and second steps to protect patients, what is next? Screening and detection to uncover hidden racism, other malignant bias, and ethical defects sufficient to permit rape or other victimization. Detection can be achieved via various means utilizing existing technology, which I'll address in a subsequent article. Today's topic is screening, which is certain to trigger controversy because one of the primary ways to do it is via lie detection: from old methods such as polygraphs to new ones such as functional magnetic resonance imaging (fMRI), in addition to promising techniques just over the horizon.
All lie detectors are fallible; the perfect one has yet to be invented. So why do it? First, if we limited medical tests to perfect ones—ones never plagued by false positives or false negatives—we wouldn't run very many tests. Second, the predictive value of imperfect tests can be improved by running multiple tests. If all or most point to a certain conclusion, dismissing them is more difficult. Multiple forms of lie detection could—and should—be utilized. Third, if a healthcare applicant knew he would be subjected to a battery of tests that evince undesirable traits, those possessing them would often screen themselves out and choose other careers.
Incidentally, it would be interesting and even entertaining to similarly screen political candidates, who often use slick methods of deception to make us believe they are better than they really are.
You don't need to be a minority or a comatose woman to be victimized by a healthcare worker with a screw loose. For example, I was physically assaulted by an emergency room nurse in a supposedly Top 100 hospital after I suggested he give oxygen to my Aunt, who was complaining of chest pain and screaming that she couldn't breathe. My Aunt was dying of cancer and I'd been with her earlier in the day at another hospital when I'd seen her projectile vomiting so much blood that I began to cry, instantly realizing this was the beginning of the end. As an ER doctor, I've seen patients projectile vomiting blood, but never as much as my Aunt, which explained her severe anemia. The nurse disputed the need for supplemental oxygen, saying they'd previously checked her pulse ox and it was OK.
First, one of the most basic principles of medicine is to treat the patient, not the number.
Second, my Aunt's condition had changed, for the worse. Her earlier pulse ox reading wasn't taken when she was this symptomatic, tearing at her gown in anguish while screaming “I can't breathe! I can't breathe!”
Third, some (not all) authorities say that “anemia will cause the oximeter to display a false high saturation when the patient is actually hypoxic.”
Fourth, people with limited knowledge often don't realize how pulse ox readings in severely anemic patients can give a gross overestimation of the blood's oxygen content. By analogy, if I limited the capacity of your wallet to store money, it could be saturated with dollar bills and you could still be in desperate need of money. Taking most red blood cells (RBCs) out of the body won't appreciably affect the oxygen saturation of the remaining ones, but the loss of RBCs limits the ability of your body to ferry oxygen from the lungs to the tissues that need it. Bottom line: blood oxygen saturation and content are two different things that are often muddled in the minds of healthcare practitioners with inadequate education.
Fifth, blood oxygen is carried in two forms: dissolved and bound to hemoglobin. When most of my Aunt's hemoglobin was sprayed onto the floor of her room, it obviously lost its ability to carry oxygen in a physiologically useful way. However, the remaining fluid in her blood vessels could still carry dissolved oxygen—not much, but enough to possibly make a difference, especially when coupled with a saturation boost thanks to the supplemental oxygen. When someone is manifesting acute distress, screaming she can't breathe and has chest pain, you'd need to have rocks in your head to withhold oxygen. I loved my Aunt, who helped pay for my medical education, so the least I could do was to speak up, so I did.
I didn't scream at the nurse or tell him what little I thought of his exiguous knowledge on this topic; I just began explaining the points mentioned above. Having been an attending physician in a teaching hospital instructing medical students, interns, and residents, I was used to clarifying mistaken ideas. However, this nurse didn't take kindly to being educated, however tactfully, so he threw the oxygen mask at me, hitting my left arm so hard that it stung for a long time afterward. The physical pain was trivial compared to the humiliation of being treated like a piece of garbage in front of my Aunt. Importantly, after I put the oxygen mask on her, she became much more comfortable, thus proving that Professor Pezzi had valid reasons for requesting oxygen. However, the Nobel Prize committee, or even a Boy Scout with a merit badge, would need more than that to be impressed because, let's face it, it doesn't take a rocket scientist or an Einstein to figure out that giving oxygen to patients gasping for breath is a good idea. Thus, I don't expect any pat on the back for suggesting oxygen, but by doing that, I certainly didn't deserve to be struck.
When a patient's relative can be struck in a Top 100 hospital for calmly suggesting a common-sense intervention, it is indisputable evidence that some healthcare personnel do whatever they think they can get away with. I've discussed other abuses in my books and websites, all of which have reinforced my belief that patients need more protection from healthcare providers who ethically are not running on all eight cylinders.
There is an unwritten rule in medicine not to criticize other practitioners. I suspect the motivation for this arises from cowardice prompted by a realization that people who mention errors may cause others to retaliate and mention their errors, creating a circle of finger pointing.
I can't tell the whole story since I've seen only a tiny slice of it, but from what I've seen, I know the problem is far worse than what most patients—and even malpractice plaintiff attorneys—suspect. My allegiance is with the truth and doing the right thing, so I shine a light on some of the hidden dirt. If even a quarter of the ugly truth eventually comes out, the public will be outraged. They are being victimized in nightmarish ways they can't even dream of. Racism, rape, and the occasional assault by a nurse from Hell are just the tip of the iceberg.
To escape the incompetence and “I don't give a hoot” attitude that is so prevalent in American healthcare, you need to be luckier than a lottery winner. Few patients are murdered because of their race or raped because of their beauty, but even routine medical procedures by nonchalant personnel can cause harm. For example, I had blood drawn by the Top 100 hospital alluded to above and found their phlebotomist made several errors. I also accompanied a friend having an ultrasound procedure at an outpatient facility owned by that Top 100 hospital, and was shocked by what I witnessed.
I think the medical education system is misguided. They make the mistake of assuming that people are qualified if they can pass tests. However, to be a good healthcare provider, you must also genuinely care about people and always be committed to doing what is best for them. Sometimes that means listening to what you did wrong and professionally addressing the error, endeavoring to never repeat it. Instead, people in healthcare are more likely to possess an arrogant “I know what I'm doing” attitude even when they clearly do not.
Perhaps you think I am a coward for not naming the Top 100 hospital, which would lead to some long-overdue housecleaning in its administration and staff. I am chomping at the bit to disclose the name of the hospital, but a good friend who works there is afraid that if I name names before she voluntarily leaves there in the not-too-distant future, they will find an excuse to fire her.
Comment #193 by Anonymous
December 30 2011 01:05:11 PM
I agree. As a physician, I, and my family have received some crappy health care over the years. The problem is, what can be done about it, short of litigation or filing complaints with licensing boards, which many times means sweeping it under the rug.