Thursday, January 1, 2015

Physicians and Psychologists Who Need...What?

Physicians need, undoubtedly, help in many areas. Besides their burnout rate and the current issue of vicarious trauma, there are several other. Many of them are engaged in a current turf battle much like that experienced between psychologists, psychiatrists, social workers, counselors and now "coaches" of every stripe. It's always about turf and it can get pretty ugly as each side tries to gird up its loins for yet another go at the other side. Reminds me of two sumo wrestlers preparing to duke it out in a sand ring. But these rings aren't so circumscribed and obvious. Mostly, they are fought in subtle public relations battles that are aimed at winning the allegiance of new people into the field and fortifying what turf they have.

Aside from the anesthesiologists battling the nurse anesthetists and the nurse practitioners and midwives battling the OB/GYNs, there are the PAs (physician's assistants) trying to find their place in the ranks of health care. Each will probably find comfort in the arms of various insurance plans that will emphasize cost containment at any cost--almost. That is until there's a major lawsuit or some truly horrendous tragedy. Then there will be the, "I told you so" sayers who will pompously sit on the sidelines feeling pretty pleased with themselves as they stamp those "For deposit only" checks.

One recent lawsuit, reported in the most recent issue of The National Psychologist, managed to gain denied autism treatment for an individual and the establishment of a $6 million fund to reimburse claimants for out-of-pocket expenses resulting from their denied claims. But there's a potentially far-reaching issue of suit which may have major implications for everyone in psychology and which will be headline-worthy for sure. This one's coming down the pike right now.

The case in point relates to the psychologists, psychiatrists and medical personnel who aided in or participated in the plan for "enhanced interrogation" used on prisoners at Guantanamo and Abu Ghraib prisons. Cries of foul and actions to change the thinking of those in positions of authority at The American Psychological Association didn't seem to receive the degree of agreement one would expect when the word "torture" comes up in a dialog on ethics and psychologists. One psychologist ran for the office of president of the APA on a platform affirming total disagreement with any psychologist being involved in any form of "enhanced interrogation" aka torture. He didn't win.

Now, when more details have come out, including the payment of over $80M to two psychologists, the topic is a fresh one that requires more action than previously shown by this professional organization. Mind you, APA was pretty much alone in not condemning these actions while the American Psychiatric Association and the American Medical Association took immediate action. Both groups totally banned members from having any role in the utilization or planning of such actions against anyone.

Suddenly, it's time for a thorough review of just what APA did or did not do relative to the issue and there is to be an internal investigation by a well-respected source, David H. Hoffman, an attorney, who has already begun stretching the parameters of his search for facts. His full report is due sometime by March 2015 and it will be interesting to see what his conclusions are. The two psychologists involved in the government's interrogations are well beyond the reach of the APA since neither is a member any longer and both have taken their millions and carved out new lives for themselves.

On the physicians' front, and unrelated to the torture, we haven't heard of any truly outrageous behavior save for the Medicare fraud cases that bob up to the surface every few months. Yes, these involve millions and many of them are for improper billing for ghost or unnecessary procedures, "patients" paid to file claims or overuse of prescription privileges for controlled substances.

What we do not hear is how those in medicine can maintain their level of knowledge and skill without ever having to show some form of verification. Although they may have "verification" it can be pretty dodgy. I've heard of one instances involving at least 15 physicians where continuing education was a matter of sitting in a room once a month and hearing about a type of case unrelated to their specialty.  Of course, anyone can make a case for this adding to their competence in some way, but what about education related to their actual specialty?

As diabetes affects more and more adults and children in the United States, there will be a growing need for special knowledge and care related to patients' kidneys. We know that diabetes is a quiet, dreadful killer that affects the heart and the kidneys as well as the nervous system and vision, but we also have learned that residencies in nephrology (the care of kidney conditions) are going begging. Will physicians in internal medicine pick up the slack and how will consumers know that they are adequately up on the research and treatments? Take their word for it? Not a very wise measure. Depend on drug companies to do continuing education? Not a wise choice, either. The conflict of interest here is much too great.

Then there's the question of physicians who are no longer able to practice because of mental impairments or alcohol/drug abuse. Who weeds them out? In some hospitals I've heard that quite impaired physicians had to have nurses guide them through a routine test to listen with a stethoscope to a patient's heart. In another hospital, a psychiatrist who suffered from alcohol-related cognitive problems actually talked back to the trees outside his hospital. They were taunting him, but no one did anything about it. He had so many car accidents that his car looked like it came from a demolition derby run. The prescription pad was still pushed his way and he signed off on anything.

Another physician, in a fit of psychotic anger, stabbed himself multiple times in the chest and was admitted to the hospital. When a relative suggested that he needed treatment and should have his license suspended, the attending physician blanched. "But they'll stop him from practice and HE'S A PHYSICIAN!" Do we really want this man out there practicing medicine without making sure he has had adequate treatment for whatever his diagnosis might be?

Many loopholes are in the current system and, in some states, practitioners are just pushed along to other venues or their cases get lost in the bureaucracy mill. Sure, like the psychologist who failed to protect a patient from ongoing sexual abuse or the one who, allegedly, shot her husband in the head so she could be with her lover. The latter case is going to trial, I should note.

Any profession has failures and weaknesses, but there are those that must be held to the highest standards and health care stands right up there.