Saturday, February 19, 2011

The face of postmodern medicine: lying

The face of postmodern medicine, where what is moral is context-sensitive, and outright clinical fabrications about "illness" (a.k.a lies) are fair game.

I don't remember anything like this in the Oath of Hippocrates:
Postmodernism is a movement away from the viewpoint of modernism. More specifically it is a tendency in contemporary culture characterized by the problem of objective truth and inherent suspicion towards global cultural narrative or meta-narrative. It involves the belief that many, if not all, apparent realities are only social constructs, as they are subject to change inherent to time and place.

Lying with a smile. This alleged physician seems to have no qualms with lying, in writing medical "out sick notes" for political purposes. Click to play video.

If this person is truly a physician, I cannot condone such behavior, that is, lying about clinical matters to suit one's own agenda, whatever that agenda might be.

I saw too much of that when I worked for the regional transit authority's medical department in a large city. Community physicians lied about injuries to support continued, fraudulent "therapy" (from which the physician - and the involved attorney - profited), and to support continued receipt of worker's compensation by the employees.

Example: months of treatment for back "strain and sprain and myofasciitis" from a 30,000-lb bus (excluding passengers!) being rear ended by a 3,000 pound car at minor fender-bender speeds. This was not uncommon. Defying known laws of physics, the force from the impact somehow traveled the considerable length of the bus, took a 90 degree turn up into the driver's air spring-cushioned seat, and strained their back.

Many of these folks failed the typical exams used to detect fakery. Example: elevating their legs to 90 degrees while sitting to remove their shoes, at which time they'd have no complaints, but then screaming loudly of back pain when in the same relative position, but supine.

Click to enlarge. A maneuver to detect exaggerated response for back pain. Somehow, the dishonest "injury clinic" docs certifying these folks as "disabled" never seemed to perform this test. All in the patient's best interest, of course...

Often, passengers on the bus would go to the same type of doctors with the same claims of injury. Sometimes as well, there would be more people claiming injury than people on the vehicle known as "ghostriders" (as opposed to ghostwriters, a frequent topic on this blog). The dishonest community physicians would certify them "injured" nonetheless.

And you wonder why your bus fare is several dollars...

Ultimately, physician dishonesty-on-an-agenda leads to a medical slippery slope that, as history proves, is not a path the profession wants to emulate.

One wonders what other lies physicians with attitudes like this proffer.

Lies in their billing, perhaps, to "stick it to the Man?"

-- SS

Addendum Feb. 27, 2011:

Along comes this story at AOL news: "Horrific US Medical Experiments Come to Light." It seems the medical slippery slopes of the not-too-distant-past, as recent as the 1960's, were more slippery than most knew.

-- SS

13 comments:

Zoltán Dani said...

Sad.

Joseph P Arpaia, MD said...

How do you know she is not a plant from the Union-busting folks to make the Union look bad. Just look at all the people who commented in that vein on You Tube. Its like the ruse of putting a few bodies dressed in the uniforms of your troops on the border to create an excuse for war.

I think that the whole thing being a fraud is more likely than a doctor being that dumb.

Scot M Silverstein MD said...

Joseph P Arpaia, MD wrote:

I think that the whole thing being a fraud is more likely than a doctor being that dumb.

There are other documented videos of similar activity, one being done by Breitbart who himself posed as a "protester" here.

Further, while you could be correct that these are not real doctors, if you read my post and note my observations about worker's comp and injury fraud engaged in by "injury docs", you might understand why I would find such physician behavior completely credible.

I used to have to deal with some real scumbags. How's about a doc diagnosing diffuse, firm lymphadenopathy in a young bus driver as "muscle knots" from that low speed collision, and letting those "knots" fester for a few months while his "treatment" of hot packs was applied a few days every week, at taxpayer expense?

-- SS

Anonymous said...

"The doctors in question are Lou Sanner, Anne Eglash, Hannah Keevil, James Shropshire and Patrick McKenna," as noted in the caption.

Joseph P Arpaia, MD said...

Amazing. I have seen that from the other side where the physician who does the IME documents an extensive history and physical which would not have been physically possible in the time the physician actually spent with the patient.

I certainly agree with your point. Digression from the truth is a slippery slope, no matter how justified one thinks it is. The means become the ends.

Scot M Silverstein MD said...

have seen that from the other side where the physician who does the IME documents an extensive history and physical which would not have been physically possible in the time the physician actually spent with the patient.

I became a preferred provider of IME's for the City of Philadelphia, police, fire, streets dept., etc.

My exams were thorough, comprehensive, and my evaluations fair. Sometimes I found for the patient, sometimes not, esp. when there were multiple inconsistencies on exam not supported by physical or laboratory findings (a.k.a., malingering).

My honest appraisals brought me many tough cases from the City's medical director at the time.

When I entered the field of Medical Informatics, little did I know it would be as corrupt as Occ Med in the big city.

In many ways, I prefer Occ Med. At least there, I could respect in an odd way the working people trying to deceive, e.g., to get away from a stressful working environment. OTOH I have little respect for academics and intellectuals in comfy positions in HIT who use their intellect for questionable purposes.

-- SS

Joseph P Arpaia, MD said...

I have seen honest IMEs too.

I do want to challenge your comparison between these docs and the ones doing fraudulent disability exams. The latter are doing it for personal gain, and may well be harming the patients, since I find that disability can easily be disabling.

These doctors writing scripts for people protesting are engaging in civil disobedience. There is no personal gain, some personal risk, and no harm to the person receiving the script.

I know of doctors who certified examinees as unfit for military service to keep them from having to go to Vietnam during the draft. I also read about doctors who "doctored" medical findings to try to make it easier for detainees imprisoned in concentration camps. I knew of such a one personally from the former Soviet Union.

While those doctors were lying, I see their actions as respectable. I am wondering how you would see them.

I'm not sure that I agree with the doctors writing absence from work scripts. However, they are clearly different from doctors who lie about disability exams.

Scot M Silverstein MD said...

Joseph P Arpaia, MD said...

These doctors writing scripts for people protesting are engaging in civil disobedience. There is no personal gain, some personal risk, and no harm to the person receiving the script.

"Civil disobedience" does not always lead to value-neutral or positive outcomes (as history shows).

In fact, as in some Middle Eastern countries of late, it can lead to anarchy, murder, takeover by unsavory elements, etc.

I view physicians expressing their personal political views via the "civil disobedience" of clinical lying as potentially reckless (a bit of playing God?), not knowing for sure the outcomes.

Every rule has an exception when the extremes are examined, of course, and doctors acting against totalitatarian, barbarous, murderous regimes to protect patients through "lying" are acting in accord with medical traditions.

I don't think the labor issues ongoing right now meet that standard. Not by a long shot. The U.S. has, in fact, a Constitution, laws and statutes to handle such matters.

That is my view.

-- SS

Scot M Silverstein MD said...

And by the way, the people receiving the scripts are likely going to collect sick pay for the time missed.

In the public sector, that's my and your taxpayer money they're getting, and they have no right to it.

I do agree, though, that doctors engaged in lining their pockets are in a different class than those engaging in "civil disobedience."

One is simply criminal; the other is just a form of ignoring the political process ("elections have consequences"), and sticking the middle finger out against those the doctors politically disagree with.

I.e., a mild form of anarchy (cf: the aforementioned Constitution, laws and statutes).

A slippery slope indeed.

-- SS

Joseph P Arpaia, MD said...

Agreed about the importance of the rule of law. Its all too easy to justify actions that are unethical, with an "ends justify the means" attitude. But all too often the long-term consequences are disastrous. And I don't think Machiavelli is a good role model for doctors anyway.

Anonymous said...

Come on - your blog is great but hyperbole about a slippery slope to Tuskegee is ridiculous. This is a political matter with no doubt some pretty intimidated teachers- see it for the solidarity and not the son of anti-science, otherwise you miss the point and join the divide and rule mob.

Scot M Silverstein MD said...

Anonymous February 23, 2011 4:56:00 PM EST writes:

your blog is great but hyperbole about a slippery slope to Tuskegee is ridiculous

I stand by my assertion that medical lying for an agenda leads to bad places. Your statement seems to imply the conceit that notorious events in medicine could never happen again. That is opinion; I am not so certain, taking a more cautious view of history.

Perhaps you can think of a less hyperbolic example of where medical dishonesty can lead.

THis example occurs to me:

I've pointed out many times on this blog that we, and other countries as well, are in the midst of a national roll out of experimental technology, health IT.

This is without robust knowledge of the risks and ignoring or lying about same, and without patient informed consent.

Medical leaders up to the national level have exhibited cavalier (at best) attitudes towards the risks to the point of willful blindness, ignoring literature such as here and here, apparently in support of another political and corporate-lobby agenda.

I repeat, I feel doctors should have stayed out of the current political battle, at least in terms of ab(use) of their credentials. Their lying is unwarranted and sets a very bad example.

-- SS

Scot M Silverstein MD said...

Note:

As other examples of where medical dishonesty and ethical lapses can lead, there's this story just released today about abuses as recent as the 1960's.

-- SS