The secret pact of silence in medicine

Imagine that you are a doctor and saw a physician make an error in an online video. Would you speak up or keep quiet? Despite the lip service the medical establishment gives to not sweeping mistakes under the rug—or six feet under, in many cases—doctors are pressured to look the other way. I've witnessed doctors doing and saying things that would make your blood boil, and I've previously written about how some healthcare workers intentionally murder patients they don't like because they might, for example, have darker skin. The healthcare industry wants people to believe that they are trying hard to improve, but that is as believable as Rush Limbaugh claiming to be serious about weight loss.

The mistakes discussed below are far from the worst I know of, but they are especially notable because the fact they were posted online indicates the doctor and major medical website seem oblivious to what they did wrong. If Bill Clinton were similarly clueless, he would post a Weekend with Monica video and then wonder why people raised their eyebrows. This raised my MD eyebrows:

If so, please tell me about it.

While doing CME on Medscape, I viewed video courses which revealed that some of the supposed sages giving those presentations don't know basic information about how to optimally sterilize skin before a surgical procedure. Courses in that section mentioned some of the horrendous infections that can result, but one video showed a physician toss a bloody gauze pad onto an obviously nonsterile area of the patient (the chest exposed by her V-neck blouse) and then reuse it, or some other pad that appeared to be bloody! The video shows what appears to be blood on his white coat sleeve (meaning his nonsterile coat likely touched her face) in addition to showing his hands touching her hair (almost certainly not sterile) and later her skin and gauze pads before and after injecting her, with several open wounds on her face. This doctor, mind you, is supposed to be someone with such expertise that he is qualified to teach other doctors.

Doctors don't have crystal balls that tell them which patients will and will not become infected as a surgical complication, so we should do everything possible to minimize the infection risk. In this video, the doctor appears to be making several mistakes, plus teaching other doctors that cavalier technique is acceptable.

I won't link to the video or show screenshots of it, which would allow the patient and physician to be identified. The latter would undoubtedly be furious that I criticized his technique, which strikes me as third-rate and evidence that he either doesn't care enough about patients or he flunked Germs 101 in med school. With the video serving as proof that I have valid reasons to question his technique, he couldn't defend his performance without seeming as if he were trying to stick up for something that falls far short of perfection. So what might he do in retaliation? If he were like others I've criticized for legitimate reasons, he would smear me, blasting me out of spite even though I am just trying to protect patients and others. In past times, people often said, “if you can't beat 'em, join 'em,” but now it is “if you can't beat 'em, smear 'em” to marginalize and discredit your critics so you can seem right even when you're wrong.

One of the central messages conveyed in my writing is that many of the supposed experts need more expertise; in fact, some appear not to know what the hell they are doing. In medicine, a lack of expertise is a big problem. Society in general has repeatedly told doctors to speak up when they spot problems, but most doctors are too spineless to ever criticize colleagues publicly or privately even when the mistake is unquestionable. I think this cowardice stems from how doctors know they all make mistakes, so if they don't criticize others, others are less likely to criticize them. There's a tacit agreement in medicine that we'll all just zip our lips, overlook misconduct and mistakes, keep pulling the wool over the eyes of patients, then do something more important: play golf, perhaps.

Not me.

I did not fully realize how impressed most people are with doctors until decades after medical school, but few physicians deserve the reverence they receive because most docs can't see the forest through the trees. The profession of medicine boils down to combating disease, but almost all doctors take an ass-backwards approach that minimizes their effectiveness but maximizes their cost. Any doc who doesn't think the path to health is paved with pills and surgery is bound to be smeared as a quack, so most practitioners spinelessly acquiesce to Big Pharma, Big Food, Big Government, and Big Insurance who know so much about keeping people healthy and happy. Dream on! If docs know so much, why do many of them look like bloated marshmallows who rarely smile?

If people were more attuned to what doctors don't know, they would not, for example, consult chubby doctors for weight loss advice. Most doctors accept what they are taught, swallowing those lessons hook, line, and sinker without questioning whether the professors they esteemed so much were correct. I once did that and patted myself on the back for how good I was at memorizing information and regurgitating it on tests, but the only things I excelled in were various procedures, connecting with 99% of people (and ticking off the other 1%), and saving a considerably higher than average percentage of patients in cardiac arrest.

An experienced head nurse told me that I was the best diagnostician he ever met. If that is true, it says more about the exiguous skills of most docs than it says about me, because I thought I generally sucked in that department except during codes when I had what seemed to be a sixth sense for quickly figuring out why the patient coded and how I could address that problem to improve the odds of a successful resuscitation—hence my better-than-average batting average of keeping patients out of the grave. But I've yet to meet a doc interested in hearing my cardiopulmonary resuscitation tips; they just want to go through the ACLS algorithms and pat themselves on the back for robotically following that simple cookbook approach. If patients and their family members knew what they were missing, they would kick them in the butt, not pat them on the back.

Ditto for weight loss. Despite weight loss surgery, artificial sweeteners, fake fats, myriad weight loss pills, diet plans, books (including my free one), videos, exercise machines and gurus galore, Americans are fatter than ever. Aside from the cosmetic implications, the link between obesity and a number of health and economic problems stemming from it makes solving this public health challenge not a $64,000 question, but a trillion-dollar one. Most docs just figuratively throw up their hands and offer the usual advice that obviously doesn't work very well.

Not me.

I have a job most people would kill for: I'm paid to sit and think, or stand and think, or build sheds and think, or do anything I want, as long as I think and share some of my thoughts with my bosses who are very rich and very smart—and hence not dumb enough to fall for the Soros-funded smear that I'm just a bag of hot air.

As I discussed toward the end of an article giving an unusually effective motivational tip, more than a few people think that Soros is an evil nut hell-bent on destruction so he can profit from the wake of that destruction, so it isn't surprising that he hates people with the desire and ability to help many others.

I am determined to solve problems, while Soros is determined to create problems—and even esteemed national leaders blast him for the problems he has so adeptly caused.

Soros is a wayward genius. Had his intellectual gifts been focused on doing good, he would be almost universally loved and respected, like an Einstein.

My bosses generally allow me to foray into anything, but sometimes they want solutions to specific problems. I've solved every challenge thrown my way but sometimes when they figuratively ask for berries, I find gold. (Since the intellectually challenged readers with Twitter-length attention spans are presumably either now comatose or surfing for something they can digest, I suppose I need not explain that we're never searching for berries—that's a figure of speech.)

One golden eureka moment came when my constantly wandering mind suddenly figured out a practical, simple, and effective solution to obesity as well as the many adverse metabolic effects that often result in people who incorrectly conclude that they dodge those problems by burning off enough calories so gravity doesn't keep them glued to their couches and Earth—figuratively speaking, of course.

My solution lets people be people, not dietary angels, yet stay healthy and lose weight or keep it off.

The price tag for obesity in the United States is staggering: $147 billion per year in direct medical costs and about $300 billion in total costs, factoring in indirect costs such as loss of worker productivity. Another source pegs the direct cost of obesity in the U.S. as $190.2 billion per year, or 20.6% of national health expenditures. Yet another source puts the total at almost $200 billion per year in the United States in medical costs and considerably more in indirect costs. Obesity has clearly grown into an epidemic that is crushing America. Over the life of a patent, my idea is thus worth trillions of dollars in the United States alone. Factor in the rest of the world and it's a goldmine.

As I'm shopping for a buyer for that invention (prototyped and proven, BTW) and related ones (my bosses are swamped with less than 1% of my ideas), and most of you are skeptical, thinking, “oh huh,” I'm working on another big one that will change the world in surprising ways. My bosses know about the latter idea but seem skeptical that it will work. However, I am long past that stage; there is no question it will work, and work wonders. I had it working years ago but wasn't satisfied with it; I wanted to slash its cost and improve its performance. Impossible? Not to an inventor used to thinking way outside the box.

I sometimes wonder where my ideas come from. I've worked side-by-side with people who are smarter than I am and yet not nearly as good at solving problems. One possible key to my creativity stems from my childhood in which I primarily raised myself after my Dad abandoned us when I was young and my Mom worked so much to support us that she never knew that I would sometimes eat in restaurants and travel to distant cities without an adult or sometimes even a friend, all before I entered kindergarten.

I grew up largely in a vacuum of supervision, and did not receive even some very basic parental lessons. Most of that is just water under the bridge now, but one effect lingered: I learned to think for myself and did my own thing, in contrast with most kids who are raised by parents who teach them what to think and how to behave. Essentially, parents have an idea of what children should be like and thus mold them into the desired end product. That inculcation is generally good but it has an inimical effect of stifling creativity.

Children are naturally creative, but that is usually beaten out of them by a culture that fears what truly creative people can do—one reason why innovative people and ideas are often ridiculed. Our culture prefers unquestioning, unthinking worker bees who happily do as they are told even when bosses and leaders clearly don't know best.

A frightening manifestation of how successful our culture has been in creating intellectual drones is the existence and prevalence of system justification, in which sheeple defend the system even if it is screwing them—as it often is. However, most people don't realize many ways in which the system harms them, such as by discouraging innovation. We are immersed in innovation, yet what we see is just a fraction of what we could have: products and services that could give us more of what we want: more fun, more security, more stuff, more happiness, better appearance, better health, lots more money, and more time to enjoy it all.

Just as products and services can be improved, people can, too. I went from dunce to doctor and beyond. Almost anyone could do what I've done, yet teachers and professors have brainwashed people into thinking that the education they give is optimal, but it is really more of a sham that's good for perpetuating a hidebound system and the job security it gives educators, not students. If educators are not bright enough to understand how education could be vastly improved at much less cost, they don't have The Right Stuff to be teaching. Unfortunately, this applies to medical educators, too, including ones on Medscape, who ought to be the cream of the crop, not in need of remedial lessons.

Kevin Pezzi, MD

The secret pact of silence in medicine

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