Saturday, February 07, 2009

"Physicians' Expected Helplessness"

At "Physicians' Learned Helplessness", HC Renewal Blog described a term coined by a lawyer and presented in an article in Medscape General Medicine.

The lawyer suggested that physicians have developed a "learned helplessness" [Bond C. The training of the "helpless" physician. Medscape General Medicine 2007; 9(3):47].

This learned helplessness obstructs physicians from standing up for their profession, its faithful execution (faithful to science and to the Hippocratic oath, the ability to be faithful being interfered with by an increasing number of opportunistic non medical interlopers), and to their own livelihoods.

Two major points the lawyer described accounting for physicians' learned helplessness are:
Beyond the basics of medical economics, young physicians are generally not introduced to the regulatory and political environment in which they will have to practice.
Young physicians become so well trained in deferring gratification that many give up on ever getting any meaningful rewards for their sacrifices. With their resilience worn away, many just give up the fight.

These are keen observations by a lawyer. I am going to coin a new term to describe what I have observed as a corollary to physicians' learned helplessness:

"Physicians' expected helplessness"

In a comment to my post "Will the U.S. spend the Economic Recovery Act's $20 billion for Healthcare IT more wisely than the UK?", where I presented a government report on a true quagmire, the UK's national program for health IT, I received a comment that:

"... I believe that you have been a little too divisive in setting the business IT crowd up as an antagonist ... the rhetoric that you use has been at times abrasive and exclusionary... implying, whatever your intention, that there shouldn't be any role in health care implementations whatsoever for IT generalists."

Ignoring the hysterical conclusion that my "intention is that there should be no role whatsoever in HIT for IT generalists" [** see note below], this comment was not at all unique.

The comment reminded me of many other comments and pieces of feedback that I and like minded medical colleagues describing healthcare and health IT incompetence and malfeasance have received over the years: "be nice."

Here's the problem.

Why do people -- including some physicians - expect physicians and other clinicians to defend their professions and ultimately the patients to whom they are responsible in an "inclusionary" and genteel manner?

People want doctors to be their staunch defenders when they are sick. They want doctors to spare no language, make no compromise in getting them the very best treatment. They don't advice doctors to be "genteel" when helping them with an overbearing and unfair denial of life saving treatment by an insurer, for example - unless the patient is Darwinian extinction-level daft, that is.

But in defending their own occupation from invasion, for example by non medical IT leaders who believe their wisdom supercedes that of clinicians in development and deployment of medical tools (electronic health records, CPOE, decision support etc.) that happen to involve computers, people expect physicians to be - passive and polite?

The union leaders defending bus drivers I observed in my time as Medical Programs Manager in the Philadelphia regional transit authority would have laughed a person issuing such a comment right out of the room. In fact, I dare say nobody would be so bold as to even issue such a weak-kneed, emasculate comment as the aforementioned indented one in the presence of such personnel.

Why, then, do people make such suggestions about 'physician political correctness', and why do some physicians buy into it?

Due to an expectation of physician helplessness, that is, "physicians' expected helplessness."

I call on my clinical colleagues to fight both physician's learned helplessness, and end others' expectations of physicians' helplessness, especially by those who count on it towards their own ends.

As one Transport Worker's Union leader said in discussing medical issues about busdrivers and other line personnel, while banging his fist on the table, "What the f*** are you idiots doing to my membership?" (I knew the union leader to be generally polite from my off hours encounters with him on the local commuter train.)

Such attitudes at crucial moments did help preserve his members' rights against edicts of senior management (who we reported to). Such directness would probably help protect physicians' rights as well, allowing them to better care for patients, and avoiding phenomena as recently described in the NY Times here: "When Doctors and Nurses Can’t Do the Right Thing."

Appeasement of non medical interlopers in medicine, who overstep their bounds and core competiencies, helps neither physicians nor patients.

It does help the career aspirations and incomes of those appeased, however.

-- SS


[**] I, in fact, teach such IT personnel at the graduate level to prepare them for facilitative roles in HIT. I am concerned, however, when such personnel are put in medical leadership roles, through either custom and tradition or managerial imperialism, that takes them outside their core competencies.


Anonymous said...

"These are keen observations by a lawyer."

and from your earlier post:

"An important article on Medscape General Medicine, by a lawyer, of all people . . ."

The implication being that you are surprised to read something written by a lawyer that is halfway intelligent??!!

InformaticsMD said...

Keen observations from a lawyer about medical psychology. Even physicians have trouble with that!

InformaticsMD said...

And by the way the original cited post with the "of all people" phrase was by Dr. Poses, not I !! :-)

Anonymous said...

It's not just in IT that physicians are expected to be "more nice." Physicians who have tried to combat medical quackery and fraud encounter the same sort of resistance. "Science doesn't know everything," it is said, and somehow it is then supposed to follow that blatant nonsense should be incorporated into medical care and accepted as just as legitimate as penicillin.

InformaticsMD said...

Anonymous wrote:

It's not just in IT that physicians are expected to be "more nice." Physicians who have tried to combat medical quackery and fraud encounter the same sort of resistance.

Good point.

In litigation over patient harm caused by EMR's and other clinical IT, I will be the first to ask CIO's and others on the stand who were in charge of these projects about their biomedical knowledge and experience.

"You mean you've never had any biomedical training, but were in charge of designing and implementing critical clinical tools, sir?"

-- SS