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.” Gee whiz, I don't wonder why; even many good Americans are more focused on style than substance.
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.
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Comment: Hospitals usually select job applicants who have the required education and license without verifying they are good people and conscientiously committed to giving the best possible patient care. A common presumption (in laymen and in administrators who do the hiring) is that people who choose healthcare careers are caring people. Some are, but many are not. Thinking about job security and good pay, they went into healthcare to help themselves, not others.
One of the main reasons I wrote books of ER stories was to illustrate how sociopaths in scrubs endanger patients. Considerably more prevalent than sociopaths are the “half-ass is good enough” folks who just don't give a hoot. They don't want to harm or kill you, but they just might because they have better things to do than to do them the right way. They often don't know the best way or just don't care, period.
If patients were truly #1, they would appreciate it if I suggested a better way to do something, but if maintaining their self-image was #1, or if enjoying the luxury of half-ass performance was #1, they would get angry when I told them they did something wrong or not optimally. That was one of my responsibilities as an ER doctor, functioning in my role as captain of the ship.
If you or a loved one were in the ER, you'd want first-rate care, so you'd appreciate a doctor like me who is committed to excellence instead of typical physicians so cowered by staff determined to do things their way that those docs place a higher priority on harmonizing with them (including the sociopaths and overly nonchalant ones) than helping them perform better.
As I mentioned in True Emergency Room Stories, my relationship with my best at-work friend ended suddenly one day after she endangered a patient's life by omitting some of the most essential steps ER personnel are trained to do. I matter-of-factly mentioned that in my office; I didn't humiliate her in front of others. I loved her like a sister, so I was as gentle as I could have been without neglecting my responsibility to inform her of what she did wrong and how she could do it better. Did she appreciate my advice or how I gave it? No. She stopped working, went into the back room, cried for hours, pouted for the next few weeks, and then transferred to another department.
Her reaction stunned me. I hadn't seen any prior evidence of emotional fragility in her, so I was surprised when it flooded out in response to a benign comment from someone who loved her. In retrospect, I wondered what she would have done if she were hammered by the chief of surgery who trained me in medical school. He was the most demanding professor I had. You not only had to know your stuff, but verbally respond when he grilled your knowledge with well-formed sentences and paragraphs, with no pauses, “umms,” or “uhs.” I somehow escaped his wrath, but he'd slam his fist on the conference room table and tell others they were “too stupid to be a doctor” while screaming at them more intensely than a Marine drill sergeant.
My girlfriend, a nurse and psychologist, doesn't have many kind things to say about nurses. One of her complaints is that most of them don't take criticism well; they overly personalize it, instead of dealing with it professionally. She says men are much better at addressing problems in a straightforward, unemotional way, but nurses (most of whom are women) are taught (she says) during nursing school to handle such problems in ways that add fuel to the fire of conflict. I don't know, because I haven't been to nursing school, but she thinks this is one of the primary flaws of the nursing profession that is (she thinks) led by people who walk around with chips on their shoulders, just looking for chances to figuratively stick knives into the backs of others. They're so eager (she thinks) to vent their rage that they train the next generation of nurses to be bitter clones of them.
I've seen evidence this is true, but also a lot of proof that it is not: I've worked with many nurses (such as Nancy, Sharon, and Larry) who were intelligent, conscientious, kind, professional, and invariably exhibited good judgment while giving superb care. I could work with them for years and have no problems with them, yet others would create problems daily or even hourly. One of the fundamental mistakes in nursing administration is not weeding out the bad apples; even supposedly top hospitals don't care. They tout their fake awards they paid for while turning a blind eye to incompetence (see my articles, Phlebotomist error in a Top 100 hospital and Infectious disease hazard of transvaginal ultrasound).
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Comment: Only a sociopath could do something like that.
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