Wednesday, March 30, 2016

How to Create a Sociopath: Part 2

This is an expansion of my original post Patient Dignity 16: From Mother Theresa to Dr. Mengele  that examines how medical school creates sociopaths. Much of the insight is derived from research in to how seemingly normal people could become Nazis and commit such human atrocities.

The link to my insights into modern medical schools creating sociopaths is the fact that physicians had been the largest professional group to join the SS.  The object of their acts were not how to rescue or cure, but to destroy and kill.

Table of Contents

Original Post: Patient Dignity 16: From Mother Theresa to Dr. Mengele 

How to Create a Sociopath: Part 1
How to Create a Sociopath: Part 2
How to Create a Sociopath: Part 3
The whole healthcare model is an aberration to social norms and mores. The only reason that society was forced to accept it was that it held the ultimate bargaining chip, our lives. When healthcare told us that their sacred and forbidden knowledge required us to be totally naked under a gown for wisdom teeth surgery as a means of infection control, we accepted it. There has been a change in thinking where we see quality of life issues (particularly mental health) just as important as preserving live. After all, who wants to live their life in a prison cell of depression and PTSD from a healthcare encounter? The internet has shared the sacred knowledge where we see that much of what is practiced is ritual and tradition rather than hard science. (Think the secrecy and traditions of the Free Masons.) Healthcare is losing its bargaining power.

Two prime examples are the "trauma log roll and rectal exam," and "DRE in constipated children."

It’s a well known scenario: The blunt trauma patient is decided to have a mechanism of trauma that warrants a trauma CT. The primary survey is nearly done. Everyone is ready to move – but, oh no!, we nearly forgot the two final steps of ATLS: the log roll and the digital rectal exam!...

For blunt trauma, there isn’t really any good evidence or theory behind the log roll. For penetrating or suspected penetrating trauma, a log roll is necessary for excluding wounds on the back of the patient...the log roll seems to be the least stable way of moving a patient – both for the spine and for pelvic injuries.

The digital rectal examination (DRE) is useless as a general screening tool in trauma, and only seems to be there for getting back at patients for waking you at 3:30 in the morning. Still, most surgeons are really anal about the digital rectal exam... in the latest version of ATLS, DRE is not mandatory anymore. So, engage brain and include the stats below in your decision making...(Source: )

US replaces x-ray for diagnosing childhood constipation: British pediatricians at a London children's hospital are using ultrasound to assess the severity of constipation in children. They have found that ultrasound is a good substitute for abdominal x-ray, with its radiation exposure, or a digital rectal examination, a procedure that children find unpleasant and disturbing. 

Dr. Bhanumathi Lakshminarayanan, a pediatric gastrointestinal specialist, and colleagues from Evelina Children's describe a system they developed for scoring ultrasound exams of constipated children in an article published in Pediatric Surgery International (December 2008, Vol. 24, pp. 1379-1384).

According to the study, the scoring system enables pediatricians to accurately measure fecal loading in a consistent manner. It also provides a tool to assess the long-term improvement of patients undergoing treatment for chronic constipation.(Source: )

Here are links that recognize that healthcare can retraumatize or be traumatic, and "trauma informed healthcare" can reduce the chance this:

Making Hospitals Less Traumatizing I like this resource because it advocates "Provide a Post Discharge Safety Net".

RETRAUMATIZING RAPE VICTIMS This is a great article!

Secondary Victimization of Rape Victims: Insights from Mental Health Professionals Who Treat Survivors of Violence This is an excellent research piece, and is something that I noticed in survivors of abuse from in, out, and both in and out of the healthcare system.

One of the most disturbing texts I have ever read was "Behaviour in Private Places: Sustaining Definitions of Reality in Gynecological Examinations." It provides the following insight: "A more drastic form of solidifying the definition by excluding recalcitrant participants is to cast the patient into the role of an "emotionally disturbed person." Whatever an "emotionally disturbed person" may think or do does not count against the reality the rest of us acknowledge."

I even explored past and present abuses committed by providers and explored the reasons that they can cognitively have occurred in "Patient Dignity 16: From Mother Theresa to Dr. Mengele."

I illustrated that "medically necessary" and "being thorough" are not always necessary, AND there are limits to "medically acceptable," namely in what is "socially acceptable" in the case of Dr. Stanley Bo-Shui Chung.

Part of what adds to the trauma is that we are (basically) told that it is in our head, it is not true (so me must be delusional), and so on. We hear that even more so when we reply with "You first." That response is because we can not believe that people who are so educated lack such basic common sense and empathy.

I also have stated, and most of you agree with me, that it is not all providers that traumatize and the traumatizations may not always be intentional.

What is even worse that we have all been missing is that we are told what happens to patients and how exams are performed IS ACCEPTABLE because healthcare says IT IS ACCEPTABLE. When we question this, we are pointed to guidelines. Even when forced to reevaluate guidelines, which only happens from multiple law suits (DREs, Brian Persaud) or legislation (pelvic exams, ACA), most providers resist and ignore the guidelines because "That is the way we have always done it."

Then physicians wonder why they have lost credibility, trust, prestige and face such high rates of burnout. It is paternalistic thinking like that that has relied on oligopolies, "sacred knowledge," and limiting access to resources that put the healthcare system where it is today. That is why physicians are becoming employees and hospitals are turning into WalMarts. It is not healthcare any more, it is the healthcare industrial complex run by bean counters and guided by patient satisfaction surveys.

“Anyone who has been admitted into a hospital or undergone a procedure, even if cared for in the most appropriate way, can feel as though they were treated like an animal or object,” says Harvard University psychologist and physician Omar Sultan Haque. Health care workers enter their professions to help people; research shows that empathic, humane care improves outcomes. Yet dehumanization is endemic.

I have stated that it is a physician's training that causes these things to happen, but the training causes a physical change in the brain of physicians. I am not making this up. This also fits in with Ray's question of making changes.

Doctors also show less empathy to patients’ pain than non-doctors do, suggesting they are not thinking of patients as having fully human feelings. A recent neuroimaging study found that, when watching a patient get pricked with a needle, physicians showed far less activation in brain areas linked to empathy. This lessening of empathy, Waytz and Haque say, likely comes from medical training. (Source: "Kellogg Insight," publication of the Kellogg School of Management at Northwestern University"A Patient, Not a Person")

So I ask, how do you fix that???

Here are the big 4 most egregious violations of children by healthcare:

The most disturbing thing about this incident is:Dr. Ramlah Vahanvaty, who performed the exams... She said, "Even a parent doesn't have the right to say what's appropriate for a physician to do when they're doing an exam."

The most disturbing thing about this incident is:They forcibly removed the clothes from numerous children between the ages of three and five--over their cries of fear and desperate attempts to resist--and proceeded to probe the genitals of the now-nude children.

Here is a story about modesty. It is the reverse of what we talk about here: High-Schooler Told to Cover Up for Exposing Her Shoulder.

There is a picture of the dress, see what you think. Lone Peak High School is in a suburb of Salt Lake City which has higher standards of modesty due to the prevalence of the Mormon culture there.

I think that the relevance of this story is in relationship to another story I referenced: LDS Hospital in Salt Lake City, Utah did as part of their overhaul of healthcare delivery in 1998:

SOME PATIENTS were especially bothered to spend half the day without underwear -- for shoulder surgery, say. Ms. Lelis was convinced this longstanding practice was meaningless as a guard against infection, persisting only as the legacy of a culture that deprived patients of control. "If you're practically naked on a stretcher on your back," she says, "you're pretty subservient." The nurses persuaded an infection-control committee to scrap the no-underwear policy unless the data exposed a problem; they have not. Source: The Wall Street Journal

Could one possibly infer that higher modesty standards of the providers led to more patient protections in 1998!

From The NY Times, "In the Hospital, a Degrading Shift From Person to Patient": The psychological dynamics of this identity change have evolved little since the 1950's, when the sociologist Erving Goffman detailed the depredations of life inside a mental institution in his classic book, "Asylums."

In normal life, people can keep intimate things like ailments, thoughts and their bodies to themselves. In an institution like a hospital, "these territories of the self are violated," he wrote. "The boundary that the individual places between his being and the environment is invaded and the embodiments of the self profaned."

Here is a great article on KevinMD, "The patient experience can be dehumanizing". Too bad the article finishes just as it begins to expose the dehumanizing practices.

... humanizing a patient's suffering positively predicted symptoms of burnout especially for those participants that had higher levels of direct contact with patients. Source:NIH PubMed, "Defensive dehumanization in the medical practice: a cross-sectional study from a health care worker's perspective."

Eight coping mechanisms were identified, including medicalization, dehumanizing the patient, anger directed at the patient, use of euphemisms, use of humor, denial of the lack of skill, going numb, and talking to others. Source:APA PsychNet, "Coping mechanisms of physicians who routinely work with dying patients."

A June 2014 study found, Nurses who viewed their patients as less human reported experiencing less stress. This was especially true for nurses who were more emotionally attached to their employer, the hospital, and to their patients. Source:Research Digest, "Committed nurses cope with stress by dehumanising themselves and their patients - Italian study"

Here are 2 consistent accounts of what it’s like to be a patient in a US hospital. Both accounts were from minors, so these patients had even less power than adult (non-elderly) hospitalized patients. These patients’ accounts bring to my mind the Stanford Prison Experiment, and how psychologically vulnerable we are when stripped of our individuality, power, voice, and control over our environment and even our bodies. "This 15-Year-Old Absolutely Nails What 'Patient Centered' Is - And Isn't" (Forbes) and "Powerless"

Here is a solution (from October 2013, Feldman says that when he brings trainees into a patient room on rounds, he has everyone introduce themselves. Even if it's unlikely the patient will remember everyone, it creates a better relationship, he says, adding that modeling appropriate behavior for interns is a good place to start. Source:Johns Hopkins Medicine News Release, "'Common Courtesy' Lacking Among Doctors-in-Training"

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