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The interfac e between doctors and administrators has always seemed to be dominated by petty politics. People are interested in money, and secondary to that, some vague sor t of reputation or power. A large and prestigious Midwestern hospital used to have a certain kind of meeti ng every few months. This hospital had only the vaguest of University associati ons — just enough to make it look academic and research oriented. I knew perfectl y well it was neither. It was a luncheon meeting of the medical staff and a few administrative types — un commonly well-catered. There were about 25 folks, but only two other women who l ooked as uncomfortable as I was. The meeting was to discuss certain hospital statistics, including some case deta ils. As the meeting agenda was passed around, the head of the hospital reminded us of the meeting “rules.” We were gently reminded that no recordings were permitt ed and neither were extraneous notes. We each received an agenda, which were ca refully counted out as they were distributed. We were told that at the end of t he meeting they would be collected — and counted — before any of us could leave. It felt like being in the first or second grade. Scanning my memory, I could no t remember having been to a meeting with this kind of rules. And I have not bee n to another meeting with this kind of rules since. I have not permitted myself to be on the medical staff of a hospital since, either. I did not want any par t of this thing. These cases are among those I heard at that meeting. They are all engraved in m y mind — permanently. 1. An older woman had all sorts of neuromuscular difficulties that seemed to be associated with low potassium. A night nurse had given her some potassium intr avenously. This nurse was at the end of her shift and was coming off a tough ni ght. She misread a decimal point, giving the woman one hundred times the amount of potassium salt the doctor had ordered. The woman died immediately in cardiac arrest. 2. There had been 11 deaths from hospital acquired infection in the period we w ere studying. It was maybe 3 or 4 months, but I do not specifically remember th at part. Most of them were from “Pseudomonas aeruginosa.” Others were from species I cannot specifically remember. Most of these were patients who had been admit ted to the hospital for pneumonia of various sorts. In every case we reviewed, the person did not die from the infection they had when they came in — usually pne umonia. In every case it was “hospital acquired.” This means it was not the infect ion the person had when they came to the hospital. Rather, it was something the y contracted while they were in the hospital. These infections are more resistant to antibiotics than the ones people bring in from the outside. I was reminded of my professor of bacteriology. She was a w ise woman who fought tears as she told our class, “Every time you prescribe an ant ibiotic, you are treating the globe.” What the prescribing doctor is doing is cre ating resistances among bacteria, so that antibiotics will not be as effective o n them later. Seven of these hospital acquired ctious Diseases was present, and lem was everywhere and there was things would be better when the infection patients had died. The Chief of Infe his remarks were brief. He said that this prob no good way to get around it. He thought maybe hospital had a new building.
3. There was a problem with surgical complication rate, most specifically post
operative infection, with one particular surgeon. The Chief of Infectious Disea ses said he would speak with that person. It was suggested there be some sort o f report at the next meeting. It struck me as strange that the other surgeons e ither could not – or would not? — review this older surgeon. The USA Today recently reported that Marty Makary, a surgeon at Johns Hopkins Ho spital in Baltimore, had written a book about transparency in hospitals and revo lutionizing health care. In the interview, he discusses how decisions are made, how incompetent doctors are allowed to keep practicing, and a whole bunch of ot her stuff I have generally seen elsewhere. During my time in hospitals, I was always the junior in a position of weakness. I will readily admit that I have generally avoided whistle-blowing in favor of self-preservation. But it was part of the culture and I was never, ever alone. The culture of physicians “protecting” each other has always been primordial throug hout the places I have been. I think Dr. Makary may be a tad idealistic. His book got published and it is at least a little acclaimed because it was revi ewed in USA Today. He probably got that review because he’s a surgeon. Idealists who never sat through medical school haven’t been able to achieve the same level of attention given to doctors. From Catholic nuns to trained nurses, to university trained ethicists, many have bent my ear with tales of doctors’ over-sized egos. I have told them that a doct or has to believe in him or herself. Doctors have never really thought other pr ofessions to be their peers. Within this context, I fear that transparency shall easily slide into pseudo-transparency. I g o e mean, look at the speeches of the current presidential elections that are bein dismantled by fact-checkers. I have never known a surgeon I would trust not t at least slightly underestimate his post-operative infection rate. I also hav never known a hospital-acquired infection official who would not underestimate a bit for the whole hospital. I do not know how much is conscious and how much is just survival. I do know people in general are fairly subjective about thin gs that impact their jobs and their pay. Physicians are human, all too often und er inhuman pressure. What if fact-checkers assaulted physicians at gunpoint, like they do presidentia l candidates? For the latter, all “truth” — or its perception — seems to have something to do with a pre-existent belief. No power is stronger than belief. As for attitudes toward doctors, there is the ever popular “transference”– a complex F reudian phenomenon that is really quite simple. Those who hate doctors will hea r only the worst. Those who view docs as loving and paternal might fall in love with them. There are those who will not hear any good, as well as those who wi ll hear no evil, and everything in between. Assuming we can get past thoughts — and that is a wild assumption at best — then the re is the public. We are not the “enlightened” public Thomas Jefferson wanted for t he United States. If we were, we would have woken up long ago. I think it would take a lot of “book-learning” for John Q. Public to interpret an ap ologia for a raised infection rate. Such an idea is in the general ball park of people taking extra time to improve their knowledge, and subsequently, take res ponsibility for their own health. The idea, the book, and hospital transparency are hard to make happen. And hard er still to use to achieve ends. However, it just simply needs to happen.