Whistle-Blowers in Medicine

[JB.]

http://montreal.mediacoop.ca/story/montreal-hospitals-facing-toxic-culture-st-marys-p/16889

[jerr]

http://montreal.mediacoop.ca/story/montreal-hospitals-facing-toxic-culture-st-marys-p/16889

 

A very interesting story. It'd be cool if there are more perspectives though, this seems to be a heavily opinionated piece of journalism.

[JB.]

I was kind of hoping to get some more info from the PM 101 community.

[ellorie]

I can't help but feel that there is more to this story...

[Med0123]

I can't help but feel that there is more to this story...

 

I agree 100%, it just seems odd that a resident claiming to be mentally sane undertake a psych evaluation.. i don't know, it's just weird

[Wayward son]

I was kind of hoping to get some more info from the PM 101 community.

 

Depends on what you are looking for. If you are looking for more on this individual case, I know nothing about it.

 

If, based on the thread title, you are looking for more information about whistle-blowing in medicine in general, I can tell you that protections for whistle-blowers is completely backwards in Canada compared to almost all first-world countries. In terms of fields I consider medicine to be among the worst for treatment of whistle-blowers and the pressure to remain silent in the face of unethical and dangerous behaviour.

 

CMAJ: Medical Whistle-blower protection lacking

 

CMAJ: Whistle-blower protection needed in Canada

 

Also there is the recently published book "Unaccountable" by Dr. Marty Makary. He is not only one of the world's foremost experts in patient safety, and research into the "culture of safety" in hospitals, but he himself originally quit medical school after third year because of these issues (a few years later he returned). Part of the book talks about a culture (and the consequences) where other health care personnel simply won't report dangerous doctors and practices. It also talks about a culture where those few health care personnel who actually do put the well-being of patients first by reporting dangerous doctors and practices are demonized, bullied and quickly shown the door.

[Wayward son]

I agree 100%, it just seems odd that a resident claiming to be mentally sane undertake a psych evaluation.. i don't know, it's just weird

 

Stressing up front that I know nothing of this incident, or the likelihood of truth to the allegations, or this person, or his motives, or the motives of others involved.

 

However, smearing the mental health of whistle-blowers is a very common and effective tactic. Often institutions will suspend a whistle-blower with the demand of a mental health evaluation done by someone of their choosing. The whistle-blower wanting to try to clear their name, and to aid in the possibility of an attempt to return to work, will get an evaluation done by an independent. A friend of mine was involved in a very similar case in Ontario within the last couple months. And keep in mind that while you are forced to remain away from the workplace, the organization and those who are opposed to your claim have free reign to attack, smear and attempt to discredit you. Even if it is shown that you were 100% correct, honest, and ethical, your reputation will have taken such a beating that it is almost impossible for you to ever feel comfortable in the same workplace if you actually return.

[shady]

I'm inclined to believe the resident. Something tells me that it is unlikely such a junior resident would be willing to risk his career over nothing. He has everything to lose if his claims are baseless. The senior faculty who has something to hide, however, will do everything in their power to paint the resident as an unstable psycho.

 

I hope this issue gets investigated. If my doubts are true, the senior faculty needs to have their license revoked.

[NLengr]

I hope this issue gets investigated. If my doubts are true, the senior faculty needs to have their license revoked.

 

Unlikely. Nobody cares for the peons (aka residents).

 

Moral of the story unfortunately, is keep your head down as a resident/fellow. Causing trouble will help nobody (the institution doesn't care, the staff will protect each other first, the university will protect faculty) and will only hurt you.

 

Even if you are a staff, raise issues at your own peril. Once again, politically motivated institutions will act in their own self interest first.

[A-Stark]

Another article here:

http://www.mcgilldaily.com/2013/03/medical-resident-says-he-was-punished-for-standing-up-for-patients/

 

I'm not sure what to make of this story. Certainly it bears all the markings of an attack on a "whistle-blower" or other "undesirable" by an organizational bureaucracy - and particularly so because I just saw a talk by Nancy Olivieri on Monday.

 

On the other hand, a resident who received two negative evaluations for being "argumentative" sounds a bit odd. However, unless McGill is a uniquely terrible place to train, I find most of the commentary in these articles a bit hard to swallow. Not to say that every single staff I've worked with has been a peach, but experiencing "humiliation" when asking simple questions has hardly been the norm. It's not as though programs don't lose (or get threatened with losing) accreditation for resident intimidation - that was the case for MUN anesthesia as recently as last year. The RC takes such things very seriously and we cannot ignore that sometimes someone who sounds like a loose cannon is a few screws short of a drill.

 

I think the US example is interesting to consider, but I don't know how relevant it is. Not to say that anything is perfect, but the Canadian system is far, far less fragmented than the American, and I don't think floridly malignant programs get to persist as such.

[mavrik13]

That's the problem with whistle blowers in medicine, especially in Canada - you have absolutely no support. Even as a staff physician, your colleagues won't come to your aid - your patients will turn against you, and the administration above you won't want to get involved. No one wants to take a risk and be wrong. I wouldn't dare undertake the course of action this resident took, it is a lose-lose situation for him.

[Fresh fry]

This article is absolute garbage and based on pure speculation. We don't know anything about the case, or about this guy. He could be completely unhinged. Where was the interview with the second year student? Where was the interview with the patient he allegedly saved? Until there are some facts this is just a smear job on McGill.

[A-Stark]

More like a smear job on McGill, by McGill, but I don't know.

 

To play devil's advocate, just exactly what was this guy whistle-blowing? Supposedly mistakes were made by "senior doctors", and that as a "junior doctor" (read R1 about five months into a family residency) he received a "crashing" patient whose life he was able to "save" by "rectifying" these mistakes. Subsequently he spoke out about these mistakes in some form.

 

Did he do this via an M&M? Did he discuss the case with his senior? Who else was on service that day and what was the nature of the alleged mistakes? There are far too many questions and the resident's account of the story is vague at best.

 

I know McGill has a reputation for being kinda "old school" but I have my doubts that this resident qualifies as a real (and self-described) whistleblower. Someone like Nancy Olivieri ended up on the wrong side of Apotex and a complicit and syncophantic hospital and university administration.

[JB.]

Unlikely. Nobody cares for the peons (aka residents).

 

Moral of the story unfortunately, is keep your head down as a resident/fellow. Causing trouble will help nobody (the institution doesn't care, the staff will protect each other first, the university will protect faculty) and will only hurt you.

 

Even if you are a staff, raise issues at your own peril. Once again, politically motivated institutions will act in their own self interest first.

 

I get why it happens, bu that mentality is so disheartening.

[future_doc]

Unlikely. Nobody cares for the peons (aka residents).

 

Moral of the story unfortunately, is keep your head down as a resident/fellow. Causing trouble will help nobody (the institution doesn't care, the staff will protect each other first, the university will protect faculty) and will only hurt you.

 

Even if you are a staff, raise issues at your own peril. Once again, politically motivated institutions will act in their own self interest first.

 

Sad but true.

[Lunasly]

If I am understanding the article correctly, would this be a malignant program? I have read stories like this on SDN and it doesn't always turn out well for the whistle-blower.

[rmorelan]

I get why it happens, bu that mentality is so disheartening.

 

and yet we recruit and demand advocates in our medical system. I certainly know how to work within a system but if pushed in a toxic system I am exactly the sort of person to speak out. At least I am aware of consequences - oh well, you have to be true to yourself in the end.

[nauru]

Just make sure you have a book deal and political career lined up before you start showing the dirt under the rug at huge medical institutions.

 

Bureaucracies exist primarily to serve themselves. That includes health care bureaucracies.

[Der Kaiser]

Bureaucracies exist primarily to serve themselves. That includes health care bureaucracies.

 

"The bureaucracy is expanding, to meet the needs of the expanding bureaucracy."

[rmorelan]

"The bureaucracy is expanding, to meet the needs of the expanding bureaucracy."

 

ha Ok that is just funny.

[apache]

the awful thing isi know people that have been experiencing inanely worse, for trying to report absolutely egregious things, for years and years. i went through way worse, but at least got an apology, some others i know have been through far worse than me, it's really sad.

[apache]

lol, having gone through it, it's a bit of a cluster **** when you know the dsm in and out... and the individual iniating the malignant acts paid for the very test that would quadruple the price of assessment... then again, it must suck having to change storage for an entire universities files, that was a few million dollars or so...

 

it's funny after refuting 20 potential diagnoses that you get sometimes you just have a hunch... indeed, someone must be short on ideas, but that's ok, these people we're forced into targeting me because of a single university individual... to bad for that person because....

 

i just want the specific individual, and i have 7500 page of law, over 40 gross violations... and it's all very cut and dry in the paper trail as well, yeah, e-mail exchanges... got those, when one of the higher ups advice is to sue the mother ****er's ass... i don't think i have to elaborate, people don't usually say that about their colleagues... then quit...

 

precedence doesn't look good for the individuals checkbook though... 6 cases of libel in 1 page, tsk... i went through the hundreds over 70 times... but i can wait... i have other things to do.. but someone has to send a message... i know people who've been through way worse for doing genuinely risking their ass to point out truly awful things... plus punitive damages for reasons i won't go into.

 

as for my experience, i can only say... now with no legal protection, have fun with my top lawyers from disability advocacy agencies... when i did it all before myself... when ive won 10 times, i can't afford to lose, and my brains different i just get mroe motivated when i fail, so i just keep pushing, eventually, Buddhism would have been a better spiritualty for one... what goes around comes around, and i feel insanely blessed... you put good out, has a way of comming back

 

"Disciplinary psychiatry" is a very well-worn tactic used by an institution to harm the credibility one of its own who surfaces serious criticisms against it.

 

Over on SDN, you hear of this kind of thing being used for residents who are in danger of being terminated for reasons unrelated to their patient care activities or ethics; in other words, they pissed off the wrong person or made someone big look bad. Witness the case of Oscar Serrano, who was unceremoniously removed from his residency at Hopkins because he reported work hour violations. He sued them, but I am unsure of the verdict, if one was reached.

 

I have nothing much to go on, but I am always very skeptical of the use of disciplinary psychiatry. The resident in question needs to procure legal counsel.

[futureGP]

Just make sure you have a book deal and political career lined up before you start showing the dirt under the rug at huge medical institutions.

 

Bureaucracies exist primarily to serve themselves. That includes health care bureaucracies.

 

McGill is also the worst place for inefficiency/bureaucracy

 

all the way from undergrad throughout medicalschool to post-grad

 

 

why do you think students in McGill protest so much?

 

lol also on that mcgilldaily article, i think i found brooksbane's comment

[FML.]

McGill is also the worst place for inefficiency/bureaucracy

 

all the way from undergrad throughout medicalschool to post-grad

 

 

why do you think students in McGill protest so much?

 

lol also on that mcgilldaily article, i think i found brooksbane's comment

 

Clearly you haven't been to University of Montreal...

[nosuperman]

Interesting, because I never left one there.

 

The "hidden curriculum" is not hidden. Many others share my views.

 

Its more "off the books and records" than hidden.