Sunday, 18 December 2016

Dangerous Doctors and Immoral Doctors

In general, if you know someone to be a danger to others you have a duty to do something about it. Exactly what you are obliged to do depends on the person, the situation and you. At the very least you ought to warn others.

In general, and apart from such basic duties as not to interfere with others (more pompously, to respect their autonomy), to keep your promises to them, not to harm them and not to burden them, your strongest duties are those you take on voluntarily, such as those you acquire by taking up a profession.

The professions hold themselves out to us as entitled to special privileges because of their special knowledge. We trust them, we rely on them, we place ourselves in their hands for specific purposes, because when paid for their work they promise to look after our interest before their own. Part of that promise is a special duty to hold members of the profession accountable to professional standards and to exclude persons who fail those standards.

So members of the medical profession have both a very strong duty and a special duty to protect us from dangerous doctors. A book has come out showing that doctors are grossly— indeed, grotesquely —derelict in this duty.

Marty Makary has published Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care. Consider this quotation:

Years ago, one of my favorite public-health professors, Harvard surgeon Dr. Lucian Leape, opened the keynote speech at a national surgeons’ conference by asking the thousands of doctors there to “raise your hand if you know of a physician you work with who should not be practicing because he or she is too dangerous.” Every hand went up. Doing the math, I figured that each one of these dangerous doctors probably sees hundreds of patients each year, which would put the total number of patients who encounter the dangerous doctors known to this audience alone in the hundreds of thousands. If, say, only 2 percent of the nation’s 1 million doctors are seriously impaired or fraudulent (and most experts agree that 2 percent is a low estimate), that would mean 20,000 impaired or fraudulent doctors are practicing medicine. If each one of these doctors typically sees 500 patients each year, then 10 million people are seeing impaired or fraudulent doctors annually. Incredulous at the numbers, I took to asking the same question whenever I spoke at conferences. And the response was always the same.

from extract online here

Just take that in for a second: thousands of doctors admitted that they personally knew a doctor ‘who should not be practicing because he or she is too dangerous’. What??!!!

It seems clear from Makarty’s remarks that those doctors did nothing about that fact.  Indeed, from something else she says it looks as if doctors who know a colleague is dangerous don’t just do nothing to protect us from the dangerous doctor, they actually protect that dangerous doctor at our risk. Consider the import of this quotation:

In other words, everyone who works in medicine knows about this problem but few talk about it. A cardiovascular anesthesiologist once described to me a colleague who was one of four heart surgeons at his well-known heart hospital. This surgeon had six consecutive deaths during routine bypass surgery. Half the operations of his last 10 surviving patients took several hours longer than the norm, often requiring the patient to be put back on the heart-lung bypass machine after having come off it. I asked my friend if he ever thought about reporting this surgeon to someone. He laughed and asked, “Like who?” The hospital administration loved this young doctor and was making a mint off his work. The senior partners were very protective of him—he covered their holiday shifts and happily tended to whatever the senior surgeons did not like to do. Whenever one of his complications was discussed at a peer-review conference, they cut him tremendous slack, attributing the death to some extenuating patient circumstance. My friend listened to all these excuses offered up in conference. As an anesthesiologist who had to work every day with the surgeons sitting in the peer-review conference, he decided to keep his mouth shut.

Obviously, the behaviour of every single one of these doctors is grossly immoral. If, as she says, it is true that everyone who works in medicine knows this problem then every single doctor is immorally failing to protect us from dangerous doctors. Furthermore, it is not as if each doctor is sitting there knowing the danger on their own. It is common knowledge, in the stringent technical sense of common knowledge. For example, once they all put up there hands at the conference, not only does everyone know it but everyone knows that everyone else knows it, etc. So there just is no excuse here. Yes, it’s hard to work out just what to do in any particular case, but what is apparent from what Makarty is saying is that doctors are doing nothing. As I said, this is a gross and grotesque dereliction of duty by doctors.

Originally at

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