by Biologist » Mon May 12, 2008 9:09 pm
From the book "Mistakes Were Made (but not by me)" by Carol Tavris and Elliot Aronson, 2007, pages 218 - 220:
"We want to hear, we long to hear, 'I screwed up. I will do my best to ensure that it will not happen again.' Most of us are not impressed when a leader offers the form of Kennedy's admission [regarding "The Bay of Pigs" apology cited in the preceding paragraph, where JFK accepted full responsibility] without its essence, as in Ronald Reagan's response to the Iran-Contra scandal, which may be summarized as "I didn't do anything wrong myself, but it happened on my watch, so, well, I guess I'll take responsibility." That doesn't cut it. Daniel Yankelovich, the highly regarded survey researcher, reports that although polls find that the public has an abiding mistrust of our major institutions, right below that cynicism is a "genuine hunger" for honesty and integrity. "People want organizations to operate transparently," he says, "to show a human face to the outside world, to live up to their own professed standards of behavior, and to demonstrate commitment to the larger society.'"
"That longing to hear authorities own up, without weaseling or blowing smoke, underlies the recent movement in the health-care system to encourage doctors and hospitals to admit and correct their mistakes. (We are talking about honest mistakes, human error, not about repeated acts of incompetent malpractice.) Traditionally, of course, most doctors have been adamant in their refusal to admit mistakes in diagnosis, procedure, or treatment on the self-justifying grounds that doing so would encourage malpractice suits. They are wrong. Studies of hospitals across the country have found that patients are actually less likely to sue when doctors admit and apologize for mistakes, and when changes are implemented so that future patients will not be harmed in the same way. "Being assured that it won't happen again is very important to patients, more so than many caregivers seem to appreciate," says Lucian Leape, a physician and professor of health policy at the Harvard School of Public Health. "It gives meaning to patients' suffering.'"
"Doctor's second self-justification for not disclosing mistakes is that doing so would puncture their aura of infallibility and omniscience, which, they maintain, is essential to their patients' confidence in them and compliance. They are wrong about this, too. The image of infallibility that many physicians try to cultivate often backfires, coming across as arrogance and even heartlessness. "Why can't they just tell me the truth, and apologize?" patients and their families lament, In fact, when competent physicians come clean about their mistakes, they are still seen as competent, but also as human beings capable of error. In one of his essays on medicine for the New York Times, physician Richard A. Friedman beautifully summarized the difficulties and benefits of owning up. "Like every doctor," he began, "I've made plenty of mistakes along the way." In one case, he failed to anticipate a potentially dangerous drug interaction, and his patient ended up in the intensive care unit. (She survived.) "Needless to say, I was distraught about what had happened," he says. "I wasn't sure what went wrong, but I felt that it was my fault, so I apologized to the patient and her family. They were shaken and angry, and they quite naturally blamed me and the hospital...but in the end they decided this was an unfortunate but 'honest' medical error and took no legal action." The disclosure of fallibility humanizes doctors and builds trust, Friedman concluded. "In the end, most patients will forgive their doctor for an error of the head, but rarely for one of the heart."
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Some interesting psychological insights there. But not enough. Not in this case. First, let's define "in this case." It is this: Since statins -- which properly prescribed would barely amount to "orphan drugs" -- are being prescribed to anyone and everyone as standard practice among physicians, where is the mistake? What did your doctor do wrong in damaging/ruining your health? After all, it's standard practice; it's the norm, Where's the downside for the physician under these circumstances, even if he knows better. And if he does not know better, where's the incentive to learn? Why read or listen to those who have done the research outside the Pharma sponsored propaganda that appears in formerly respected medical journals. Why rock the boat or swim against the tide particularly when it could damage a career? As they say "Its hard to get someone to understand that which their financial well-being depends on them not understanding." Doctors, to my knowledge, CANNOT be sued for the malpractice of prescribing statins under a disproven theory of heart disease known as the "Lipid Hypothesis" even when formerly healthy patients now wheelchair into their offices with all the classic debilitating "side effects" only to leave with a new prescription doubling the dosage. And try to find a doctor who does not hug the conscience mollifying security blanket of an awareness that "wayward doctors" are being sued en masse across the land for having failed to lower a patient's cholesterol when such patients suffer an adverse heart event. It makes no difference that this is a myth. It is a comforting myth. It soothes and justifies.
Besides, if all the doctors are all so wrong, thats perfect because when everybody is to blame, nobody is to blame. (For example, how do you prosecute and punish nearly half the country for helping reelect a richboy sociopath to the highest office in the land? See what I mean? It cannot be done, well not beyond what we all will suffer in the future because of it.) The point is, there is safety in numbers. All together, this is the perfect storm.
So forget the numbers. Address the individual doctor instead. Consider creating a website describing what your doctor did to you in the face of all that is known about stains. Tell the truth, and nothing but the truth -- and that will be more than enough. Name him repeatedly on the website/webpage. Google will pick it up and the site will show up near the top of a Google search under his name. Their reputation may take a beating, and their wallets may take a beating, but it is a small price for them to pay for all the good it could do for others. And after all, helping others is what doctoring is all about. With your help, and by their selfless sacrifice of their reputation, others may be spared in the future (i.e., both patients and newly incentivized doctors.) A new myth may circulate across the land within the profession: "Fellow doctors, we can actually be held accountable by those we damage, just look what happened to this doctor by going to 'his' new website." The first incentive will have been created -- as a counterbalance -- for doctors to actually do the right thing instead of the easy thing. And its no myth.
Biologist