Few people can imagine the frustration of constantly knowing you see and understand a social phenomenon “no one else” comprehends. I believe I see and understand the dual professional dilemmas, medical malpractice and medical peer review, far better than any other person in America.
Furthermore, I believe almost everything heard or read regarding those subjects is based upon flawed fundamentals and distorted logic. More importantly, very little of my belief is based upon “my opinion”, which, like a Star Bucks latte and $5.00 will get you a small (grande in their language) and some change.
The vast majority of that understanding of medical malpractice and medical peer review is based upon facts taken from the medical profession’s own literature and other related sources.
How might a lone heretic overcome the concentrated public relations, media savvy might of Organized Medicine and federal and state bureaucracy? Only through a discerning public. Discernment demands that the listener differentiate between fact and rhetoric.
Organized Medicine (AMA, Joint Commission, AHA, etc., etc.) and non-medical profession sources can literally engulf an interested audience with mountains of literature, past, present and to be created.
Few people are old enough to remember Dragnet’s Sergeant Friday, “The facts, madam, just give me the facts.”
Organized Medicine’s defense of their past track record regarding the administration of their profession will be “a day late and a dollar short” if only documented facts are accepted in rendering a judgment.
The problem occurs because the “facts” regarding each subject (malpractice and medical peer review) get lost in the fact-less rhetoric. Discernment between fact and rhetoric requires time and effort, two commodities most of the public and few in the media offer either medical malpractice or medical peer review.
The public must choose if they want to continue just talking about healthcare change or do they finally want to begin making healthcare change happen?
I recently had a person at the highest level of business leadership ask me, “But, what can I do?” If a person at the highest level of business leadership can ask, ‘But, what can I do?’, where does that leave everyone else?
Is it any wonder that we’ve spent the last 20 years just “talking” about the need for healthcare change? That need is so obvious, but the ability to direct meaningful healthcare change has been missing. And it is also obvious that Organized Medicine will never be one of the guiding forces for such change.
I can direct interested parties toward positive healthcare change – NOW! A “desire” for healthcare change merely offers more of the same.
Get involved if you truly want healthcare change. The public needs to “look back in anger” and say “Enough talk, lets do something positive.”
Friday, June 29, 2007
Friday, June 22, 2007
Why Me?
I have been asked, why has an oral surgeon become so involved with medical malpractice? One incident, which began in 1979 and continued for several years demonstrated the enormous void between the vocalized professionalism of the practice of medicine and the unprofessional reality of questionable patient care.
Patients only have the rights our medical profession can demonstrate to be in existence.
I was asked to assume the responsibility to treat a patient whose condition, after several months of treatment by two other surgeons, was worst than her original injury. After treating and stabilizing her shocking, doctor-induced disability, I reviewed the hospital records of her previous two hospital admissions and surgeries.
Medical incompetence is the most civil description one might apply to her previous surgical care. My conclusion was that those two surgeons, over a four-month period, had done nothing right and everything wrong. After a brief meeting, requested by me, the senior of the two surgeons announced, “We did nothing wrong.” A simple fracture of the lower jaw, which typically required six weeks for satisfactory healing, had turned into three hospital admissions, three surgical procedures, months of antibiotic therapy, and they had done “nothing wrong”.
As a member of that hospital medical staff I felt it my professional duty to present my concerns to the hospital medical director. My reward was to be asked, “Are you a trouble-maker?” So much for patient’s rights.
Despite the unprofessional slur, I demanded, without the patient’s knowledge, that a review of her care be accomplished. The term “circle the wagons” is appropriate with the findings of their surgical peer review committee. There was not a single positive factor related to her first two hospital admissions and surgeries, yet that peer review committee could find no evidence of unacceptable care. That hospital’s acceptable standard of care for the treatment of simple fractures of the lower jaw could only be breached, apparently, if the patient had died.
Additional patient care review of that case was forced, by me, through every level of medical staff review, including the medical staff executive committee and NO fault with her care was ever indicated. Subsequently, review of her care was also found acceptable by the hospital system’s board of governors and the JCAH.
I had listed several elements of clearly substandard patient care, all documented in the patient’s hospital record, for each of the medical staff committee reviews and each level of medical staff review found no evidence of unacceptable care.
I presented the detailed evidence of her care and a list of all of the medical staff committees’ reviews to the doctor in charge of the JCAH review of that hospital several months after the hospital system’s board of governors had also found her care to be acceptable. There is no evidence that the JCAH took notice of all of the questions arising from her previous care.
Both surgeons were later found guilty of negligent care regarding that case.
Why is an incident, even a shockingly horrible incident of inept medical peer review extending up to and including the JCAH, a worthy consideration? Medical peer review is one of only three systems with the “potential” for questionable patient care review, and one of those three systems, state medical examining boards, is shown to be of no value in that regard.
Medical peer review has been given the state and federal privilege of being secret for over twenty years. Every hospital medical staff has the presumed responsibility to provide a functioning system of medical peer review. Yet no community in America has ever been provided evidence that medical peer review exist, much less functions, in cases of questionable patient care.
Does anyone care?
Patients only have the rights our medical profession can demonstrate to be in existence.
I was asked to assume the responsibility to treat a patient whose condition, after several months of treatment by two other surgeons, was worst than her original injury. After treating and stabilizing her shocking, doctor-induced disability, I reviewed the hospital records of her previous two hospital admissions and surgeries.
Medical incompetence is the most civil description one might apply to her previous surgical care. My conclusion was that those two surgeons, over a four-month period, had done nothing right and everything wrong. After a brief meeting, requested by me, the senior of the two surgeons announced, “We did nothing wrong.” A simple fracture of the lower jaw, which typically required six weeks for satisfactory healing, had turned into three hospital admissions, three surgical procedures, months of antibiotic therapy, and they had done “nothing wrong”.
As a member of that hospital medical staff I felt it my professional duty to present my concerns to the hospital medical director. My reward was to be asked, “Are you a trouble-maker?” So much for patient’s rights.
Despite the unprofessional slur, I demanded, without the patient’s knowledge, that a review of her care be accomplished. The term “circle the wagons” is appropriate with the findings of their surgical peer review committee. There was not a single positive factor related to her first two hospital admissions and surgeries, yet that peer review committee could find no evidence of unacceptable care. That hospital’s acceptable standard of care for the treatment of simple fractures of the lower jaw could only be breached, apparently, if the patient had died.
Additional patient care review of that case was forced, by me, through every level of medical staff review, including the medical staff executive committee and NO fault with her care was ever indicated. Subsequently, review of her care was also found acceptable by the hospital system’s board of governors and the JCAH.
I had listed several elements of clearly substandard patient care, all documented in the patient’s hospital record, for each of the medical staff committee reviews and each level of medical staff review found no evidence of unacceptable care.
I presented the detailed evidence of her care and a list of all of the medical staff committees’ reviews to the doctor in charge of the JCAH review of that hospital several months after the hospital system’s board of governors had also found her care to be acceptable. There is no evidence that the JCAH took notice of all of the questions arising from her previous care.
Both surgeons were later found guilty of negligent care regarding that case.
Why is an incident, even a shockingly horrible incident of inept medical peer review extending up to and including the JCAH, a worthy consideration? Medical peer review is one of only three systems with the “potential” for questionable patient care review, and one of those three systems, state medical examining boards, is shown to be of no value in that regard.
Medical peer review has been given the state and federal privilege of being secret for over twenty years. Every hospital medical staff has the presumed responsibility to provide a functioning system of medical peer review. Yet no community in America has ever been provided evidence that medical peer review exist, much less functions, in cases of questionable patient care.
Does anyone care?
Friday, June 8, 2007
Doctors say the darndest things!
Art Linkletter, where are you when we need you? Doctors, like kids, can say the darndest things, but unlike kids, too often, what they say is not very funny. Organized Medicine has, in the past few years, made some incredulous public statements which should have demanded being questioned and were, instead, quietly accepted as gospel.
AMA produced thousands of colorful, tri-fold brochures in 2003 entitled Will Your Doctor Be There? The first full paragraph of that brochure begins with the phrase, “The primary cause of America’s medical liability crisis is -----.” To properly understand that statement one should appreciate the medical significance of the first three words; “The primary cause”.
The primary cause is the bedrock of all medical intellectual endeavor and is the holy grail of diagnostic medicine. Therefore, anything described medically as “the primary cause” has been given the greatest significance. I gained great appreciation for that phrase early in my surgical training. My six month rotation on the Pathology Department staff required me to perform 35 autopsies. The goal of an autopsy is to determine the primary cause of death, as well as any secondary, contributing causes.
I have belabored the point for good reason. Medical pronouncements of “the primary cause” are not merely casual designations. Now, back to their unquestioned statement.
Greedy, overzealous attorneys are the primary cause of the medical malpractice crisis. So says that AMA brochure which was meant to be placed in doctor’s waiting rooms for patients to take home and read. Let’s see how that occurs. Someone has surgery and days, weeks or months later there is clear evidence of post-surgical problems. How, when and where did an attorney create the problem?
Doctors have caught the Great American Syndrome, “Something bad happened, but its somebody else’s fault!” Far more important, however, is the fact that no one has ever questioned the AMA to clarify the fundamental disconnect between fact and the premise of their declaration. If medical malpractice is a medically induced human fault, how can attorneys, or any other non-medical source, be “the primary cause”?
“Legally acceptable medical standard of care is set at the lowest possible rung.” That statement was made by an AMA past-president who has both a medical and a legal degree. I term this definition of legally acceptable medical care to be the “onion-skin” rule. There is an onion-skin between the legally acceptable medical standard of care and that patient care which should be judged substandard care or medical malpractice.
Notice should be taken that the AMA does not speak of where the medically acceptable medical standard of care is positioned since questionable patient care is predominately judged through the medical liability system of civil court.
That same dual-degree AMA past-president offered doctors with Organized Medicine’s latest definition of medical malpractice, also in 2003. “Medical malpractice is treatment beneath a standard of care set by the law.”
String those three statements together; attorneys are the primary cause of the malpractice crisis, legally acceptable medical standard of care is set at the lowest possible rung and medical malpractice is treatment beneath a standard of care set by the law. A very disquieting pattern seems to emerge.
Organized Medicine never declared in a colorful, tri-fold brochure widely distributed to the nation through doctor’s waiting rooms that medical malpractice litigation was the principle system for the review of questionable patient care. That revelation was never communicated to society by the profession, but the overwhelming evidence is that our medical profession chose malpractice litigation as the system of choice for the review of questionable patient care.
Organized Medicine has a litany of highly questionable statements which have completely avoided public demands for clarification. No other facet of American society appears to enjoy such unquestioned acceptance of all declarations. Strange!
Art Linkletter, where are you when we need you? Doctors, like kids, can say the darndest things, but unlike kids, too often, what they say is not very funny. Organized Medicine has, in the past few years, made some incredulous public statements which should have demanded being questioned and were, instead, quietly accepted as gospel.
AMA produced thousands of colorful, tri-fold brochures in 2003 entitled Will Your Doctor Be There? The first full paragraph of that brochure begins with the phrase, “The primary cause of America’s medical liability crisis is -----.” To properly understand that statement one should appreciate the medical significance of the first three words; “The primary cause”.
The primary cause is the bedrock of all medical intellectual endeavor and is the holy grail of diagnostic medicine. Therefore, anything described medically as “the primary cause” has been given the greatest significance. I gained great appreciation for that phrase early in my surgical training. My six month rotation on the Pathology Department staff required me to perform 35 autopsies. The goal of an autopsy is to determine the primary cause of death, as well as any secondary, contributing causes.
I have belabored the point for good reason. Medical pronouncements of “the primary cause” are not merely casual designations. Now, back to their unquestioned statement.
Greedy, overzealous attorneys are the primary cause of the medical malpractice crisis. So says that AMA brochure which was meant to be placed in doctor’s waiting rooms for patients to take home and read. Let’s see how that occurs. Someone has surgery and days, weeks or months later there is clear evidence of post-surgical problems. How, when and where did an attorney create the problem?
Doctors have caught the Great American Syndrome, “Something bad happened, but its somebody else’s fault!” Far more important, however, is the fact that no one has ever questioned the AMA to clarify the fundamental disconnect between fact and the premise of their declaration. If medical malpractice is a medically induced human fault, how can attorneys, or any other non-medical source, be “the primary cause”?
“Legally acceptable medical standard of care is set at the lowest possible rung.” That statement was made by an AMA past-president who has both a medical and a legal degree. I term this definition of legally acceptable medical care to be the “onion-skin” rule. There is an onion-skin between the legally acceptable medical standard of care and that patient care which should be judged substandard care or medical malpractice.
Notice should be taken that the AMA does not speak of where the medically acceptable medical standard of care is positioned since questionable patient care is predominately judged through the medical liability system of civil court.
That same dual-degree AMA past-president offered doctors with Organized Medicine’s latest definition of medical malpractice, also in 2003. “Medical malpractice is treatment beneath a standard of care set by the law.”
String those three statements together; attorneys are the primary cause of the malpractice crisis, legally acceptable medical standard of care is set at the lowest possible rung and medical malpractice is treatment beneath a standard of care set by the law. A very disquieting pattern seems to emerge.
Organized Medicine never declared in a colorful, tri-fold brochure widely distributed to the nation through doctor’s waiting rooms that medical malpractice litigation was the principle system for the review of questionable patient care. That revelation was never communicated to society by the profession, but the overwhelming evidence is that our medical profession chose malpractice litigation as the system of choice for the review of questionable patient care.
Organized Medicine has a litany of highly questionable statements which have completely avoided public demands for clarification. No other facet of American society appears to enjoy such unquestioned acceptance of all declarations. Strange!
Saturday, June 2, 2007
Friend or Foe?
This blog has begun with several negative, even hostile encounters with our nation's medical profession. Consequently, it is fitting and proper to question the author's underlying motivation. Am I the doctor's friend or foe?
It is rapidly approaching fifty years since I was pronounced to be a professional and a member of a time-honored profession. Society is fortunate that few persons so honored dishonor that privileged status by transgressions. Most medical and dental professionals strive to do good.
I love and respect my profession (dentistry), my specialty (oral surgery) and my co-profession (medicine) as much as one can. Love, however, demands confrontation when the subject of that love appears to be on a path toward self-destruction. When it comes to the review of questionable patient care, doctors have always been their own worst enemy.
Society passively, and federal and state governments actively, have rewarded our nation's medical profession with far too much self-regulation and control. The results have been disastrous for all. Medical practice is the least regulated economic activity in America - and always has been. That is a theme which will constantly reappear in future blogs until some authority can prove otherwise.
Attention for this blog must be refocused on the author's underlying motivation: friend or foe?
Our cuture has recognized, named, and classified a fairly new response when loved ones appear to be on a pathway leading to self-destruction. It is called intervention. Uniquely, in this instance, one person (author) is seeking to perform an intervention with the many (medical profession) as an act of love. I am NOT the enemy!
Interventions, however, require harsh truths be told and in so doing one can easily be preceived as the "enemy" when the exact opposite is the intent.
I was recently speaking with the healthcare guru on the staff of one of South Carolina's Senators. The question arose, "Was I intending to confront doctors with my thesis, doctors are the only cause of the long-standing medical malpractice crisis and doctors are the only cure for that crisis?" That does seem to be the currently acceptable mechanism used in interventions, confront the misguided in the hope of redirecting them to a more beneficial mode of conduct.
Is there a gentle manner in which learned individuals can be made to understand that their entire profession has traveled a self-destructive pathway, medical malpractice litigation, and that their only professional salvation can be found in medical peer review? All such recommendations would be gratefully taken in to advisement.
Therefore, thsoe who might view the author's intent as hostile and uncaring would be mistaken. A more loving attempt at the intervention of an entire profession can not be found.
Jacques Barzun, who wrote the 800 page From Dawn to Decadence, 500 years of Western Cultured Life after age 90, also wrote in The Profession's Under Siege, Harpers Magazine, 1978 the following quote,
"What all the professions need today is critics from inside, men who know what the conditions are, and also the arguments and excuses, and in a full sweep over the field can offer their fellow practitioners a new vision of the profession as an institution."
I can offer a new vision for the medical profession.
It is rapidly approaching fifty years since I was pronounced to be a professional and a member of a time-honored profession. Society is fortunate that few persons so honored dishonor that privileged status by transgressions. Most medical and dental professionals strive to do good.
I love and respect my profession (dentistry), my specialty (oral surgery) and my co-profession (medicine) as much as one can. Love, however, demands confrontation when the subject of that love appears to be on a path toward self-destruction. When it comes to the review of questionable patient care, doctors have always been their own worst enemy.
Society passively, and federal and state governments actively, have rewarded our nation's medical profession with far too much self-regulation and control. The results have been disastrous for all. Medical practice is the least regulated economic activity in America - and always has been. That is a theme which will constantly reappear in future blogs until some authority can prove otherwise.
Attention for this blog must be refocused on the author's underlying motivation: friend or foe?
Our cuture has recognized, named, and classified a fairly new response when loved ones appear to be on a pathway leading to self-destruction. It is called intervention. Uniquely, in this instance, one person (author) is seeking to perform an intervention with the many (medical profession) as an act of love. I am NOT the enemy!
Interventions, however, require harsh truths be told and in so doing one can easily be preceived as the "enemy" when the exact opposite is the intent.
I was recently speaking with the healthcare guru on the staff of one of South Carolina's Senators. The question arose, "Was I intending to confront doctors with my thesis, doctors are the only cause of the long-standing medical malpractice crisis and doctors are the only cure for that crisis?" That does seem to be the currently acceptable mechanism used in interventions, confront the misguided in the hope of redirecting them to a more beneficial mode of conduct.
Is there a gentle manner in which learned individuals can be made to understand that their entire profession has traveled a self-destructive pathway, medical malpractice litigation, and that their only professional salvation can be found in medical peer review? All such recommendations would be gratefully taken in to advisement.
Therefore, thsoe who might view the author's intent as hostile and uncaring would be mistaken. A more loving attempt at the intervention of an entire profession can not be found.
Jacques Barzun, who wrote the 800 page From Dawn to Decadence, 500 years of Western Cultured Life after age 90, also wrote in The Profession's Under Siege, Harpers Magazine, 1978 the following quote,
"What all the professions need today is critics from inside, men who know what the conditions are, and also the arguments and excuses, and in a full sweep over the field can offer their fellow practitioners a new vision of the profession as an institution."
I can offer a new vision for the medical profession.
Subscribe to:
Posts (Atom)