Dec 21, 2009

The Battle Against Incompetence

A while back Nurse K asked a really good question:

How do doctors deal with colleagues that they know are incompetent? Keep your mouth shut? Frank discussion with the medical director? Anonymous letter?
Doctor D has two ways of answering this question. One makes him look really awesome, and the other exposes him a part of the problem. Doctor D will start out all the heroic stuff and then tell you more in the next week:

Doctor D once worked at a place called Crayzee Clinic, because he really wanted to practice primary care in an underserved community. (What a saint! Let's give Doctor D a Nobel Prize or something!) Unfortunately the clinic came with a partner we shall call "Crayzee Colleague."

Now Crayzee Colleague was pleasant enough, but the medicine she practiced didn't even remotely resemble proper standards of care. Doctor D, being the totally nice dude that he was, thought maybe Crayzee Colleague was just behind the times and hadn't heard of the cool new stuff doctors have been doing for these last fifty years. D mentioned his concern in the gentlest possible way, but would you believe it, Crayzee went nuts! She called D a "young doctor who doesn't know shit."

So Doctor D printed out some info for Crayzee Colleague on how medical care is done in this century to prove that he isn't the only one who believes in things like vaccines, mammograms, and such. Unfortunately nothing changed about Crayzee Colleague's incompetent care.

Doctor D was worried because he shared patients with Crayzee Colleague and the stuff she did wasn't exactly safe. From time to time he sent her pleasant little notes reminding her about sensible medical care as he was cleaning up her disastrous work. After a few months of this our hero realized Crayzee Colleague had no interest in changing anything.

Since Crayzee Clinic was federally funded, Doctor D figured he should go up the ladder and speak to "The Man." The Man isn't a doctor, but he has a fancy title, sits behind a big desk, and supervises a whole lot of doctors. D figured his colleague would surely listen to The Man. So D informed The Man that he was very worried about Crayzee Colleague's care. The Man said "Doctor D you are right. Crayzee should step up her game."

And then nothing happened.

Crayzee Colleague kept providing downright dangerous care, ignoring D's still friendly but increasingly firm reminders to at least try to practice something resembling primary care.

Finally, Doctor D had enough of Crayzee Colleague doing dangerous shit to his patients. He blew the whistle as loud as he could. He warned every healthcare bureaucrat he could find, "Look, if Crayzee Colleague keeps doing this stuff that endangers patients I will resign from Crayzee Clinic and tell every patient I see on my way out that I'm leaving because the care here is a treat to public safety!" And still nothing happened.

So Doctor D did exactly as he had threatened he would.

At the end of our story The Man's bureaucracy remained intact, Crayzee Colleague was still at the clinic, and Doctor D had all his principles but no job in the middle of the Great Recession.

...but Doctor D is still proud he opened that can o' whoopass on medical incompetence as well as The Man and his Crayzee Clinic.
Please feel free to praise the fearless Doctor D in the comments section! Get his ego good and inflated because next week he has to make some confessions that will disappoint you.


Nurse K said...

Wow!!! You really stood up for good over evil!!! What a great doctor you are!!!

PS I recommend writing a secure email with patient name(s), date(s) of service, medical record number, and EXACT concern. If you tell something to The Man verbally, nothing will get done. If you say something general like "Crayzee doesn't practice up to standard of care", no one is going to do anything either because no one has the time to sift through a bunch of random charts.

Anonymous said...

Dr. D, it gives me hope in this mean old world to know you stood up for what was right, and that you were concerned enough about the care the patients at Crayzee Clinic to do some whistle blowing. That said ... people like Dr. Crayzee exist in just about every profession. Sometimes it seems like their mission in life is to make US crayzee, too. And then add on layers of bureaucracy and comfortable, complacent people unwilling to rock the boat ... Well, you did the right thing, even if the result wasn't what you hoped for. At least you can sleep at night.

As for what you'll be writing next, well, I'm ready. And you know what? None of us are perfect, not even SuperDocs.

K said...

You should have looked up all the patients that exprienced an adverse outcome under her care and told them to seek out a lawyer. If you can't force her out through bureaucracy, you can make it too expensive for her to practice

WordDoc said...

The one and only time I began the steps needed to ease an incompetent doc out of a joint practice, she moved out of the office in the middle of the night and sued the remaining doctors.

Maha said...

Another nurse and I were talking about crazy (sorry, crayzee) colleagues and how to deal with them. Sadly they are protected by behemoth bureaucracies. I still get intimidated by older colleagues who I know are not doing the best they can but your post is adding to the courage reserves - that is until your next post in which you will make disappointing confessions!

Anonymous said...

Having been the victim of a quackapodamus (I was having asthma attacks; he told me it was bronchitis and gave me an antibiotic and a cough syrup. I ended up in the hospital for a week and almost died.) I appreciate your efforts in educating this person. I wish I had known how bad this guy was. It would have saved me a lot of time, money, and suffering.

Doctor D said...

Thanks to everyone for the encouragement. My ego is feeling awesome right now! Sorry I'm going to have to be the looser in the next story.

By the way Nurse K, I started out with just verbal discussion, but once I realized that I was up against intractable stupidity I started putting everything in writing and including names and dates. I figured that would put the fear in them, but some people are too stupid to fear the consequences of their actions.

I'm sure Crayzee Colleague has probably killed in the past, but I never saw absolute proof of a severe adverse outcome due to her incompetent care during my brief work with her. I'm sure this is a testament to the ability of the human body to heal itself in spite of very bad medicine.

I don't think we should let recklessly irresponsible docs keep being dangerous just because we can't prove they actually killed someone, anymore than we should let drunk drivers stay behind the wheel till they claim victims. The fact some drunk drivers or bad doctors haven't yet killed is more because of luck than anything.

I have a whole lot of info about the care at Crayzee Clinic stored in a folder in a safe deposit box. If a lawyer ever calls me about a case I will be happy to contribute some data they would find very interesting.


Bravo, whether or not your next blog is a doozer, the fact is you have at one stage stood up to Dr useless and been more 'man' than most men.

We need more people who are doing their job and protecting people from possible harm.

I applaud those who are not too scared to open there eyes and see the truth...
Waiting for your next blog :)

Anonymous said...

Doctor D clearly is a phabuloso physician. It will be hard to convince me otherwise, no matter what skeletons he takes out of his closet in the next post.

One time when I was hospitalized, I was assigned to a nurse who seemed like a boozy Sophia Loren. A nurse who had cared for me earlier came in and said, "You have Nurse Zeecray tonight. If you need ANYTHING, you call ME. Don't call her." He seemed worried and angry. Fortunately, it was an uneventful shift. Nurse Zeecray was peculiar but only did things like come in in my room at 2 am to implore me to eat "soft pooding" and other snacks. I gathered the other nurses thought she was unfit but had no way to stop her from working there. It seems this sort of thing is a problem in many hospitals.

Anonymous said...

Is there any way a doctor can instigate investigations into standards of care?

If not, I think in that place, in addition to what you did, the only other thing to do is encourage patients to file complaints with the state medical board and tell them how to do it. It is...infuriating when bureaucracies won't or can't budge when someone is failing at their job, especially when they're failing in a way that is endangering people.

Was she violating explicit standards of the bureaucracy, or standards of care? The former is easier to go after than the latter.

...sadly, this is one of the places where sometimes, lawyers come in handy. On the whole, I think people are too litigious, but...when you're talking about a state-funded entity that's endangering people, sometimes the smackdown has to come from another state power. There's nothing like a judicial order to make a bureaucracy at least attempt to fix itself.

Doctor D said...

She was violating standards of care. Unfortunately there is no gentle corrective way of setting a colleague strait who isn't open to the possibility their care could be wrong.

Malpractice is an option, but it is a huge ordeal and would have involved a million dollar lawsuit that could have shut down the clinic.

It's like there's no way to tell a stubborn captain he is on the wrong course without sinking the ship.

Anonymous said...

Yeah, med-mal is a mess. I frankly think we are desperately in need of a better way of managing badly done medical care. However, as yet the legislature hasn't created one.

Yet another reason we need to get doctors and patients working together to pressure the legislature to make better laws. Unfortunately, especially because of med-mal suits, too often doctors and patients find themselves pushed to oppose each other instead of working collaboratively towards a solution that is better for everyone.

I'll admit I haven't thought about it enough to have any real suggestions. I'm more in the arena of disability rights/access/discrimination/SSI sort of things - my interest in medical law is kind of tangential.

Polly said...

Hi! I just found your blog and love it! I know this is a late reply, but I wanted to share a very similar experience (albeit in a completely different field) I went through a few years ago.

I was working in a children's museum, and a woman on staff there was a sexual compulsive--she sexually harassed male staff, acted out sexually in front of minors, etc. I spent about a year-and-a-half trying to get her (and eventually her useless supervisors) fired. Like you, I went up the ladder and talked to everyone I could think of. Everyone told me it was a very serious problem and they would take care of it; nobody did a damned thing.

When it became abundantly clear that her record there was absolutely spotless (she was hired into my department while I was out of town, which represented a significant promotion for her), I resigned in protest. And nothing appeared to come from that. It was one of the most frustrating experiences of my life, and the lack of professionalism shown by so many people has soured me on ever working in the nonprofit sector again.

Roughly a year later, however, the vice president of human resources was fired, and I believe that woman no longer works there. So some people did, eventually, get at least some small portion of what was coming to them. Although my resignation clearly did not resonate with the people in charge, I think it did affect the people I worked with (my supervisor in particular was not happy about the situation), and that may have eventually had an impact. So your actions likely did do some good, even if you can't see it from where you are now.

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