why the doctors are wrong? by Jeannegda catherine Valverde farias, Sr
STATEMENT OF CLAIMS AGAINST MEDICAL STAFF
Among the most frequent causes of medical complaints of delays in care for the sick, and errors in diagnosis, the fatal consequences of performing diagnostic and therapeutic procedures, application of wrong behaviors or incomplete treatments mentioned (partial tumor resection). In the United States (US), it is almost a custom sue for medical malpractice for various reasons such as high fees charged by doctors, the loss of the doctor-patient relationship, the existence of malpractice insurance and attitude lawyers. (172)
TRIAL AND MEDICAL LEGAL ALLEGATIONS
“Fiat iustitia et ruat caelum”. Latin aphorism
Today, the patient is aware that he can sue the doctor if you are not happy or satisfied with the result, patients are demanding more humane care while specialists complain of lack of time and resources. The "trial industry" in the health field, far from diminishing advancing at a dizzying pace that is good for nothing but smother the moral and economic health system of a country. In Spain, 50,000 annual malpractice complaints are recorded, according to the Patient Ombudsman, 60% more than 10 years ago.
There are times when the doctor often confronted with the dilemma of what to do for the good of the patient, and what the likely actions is more favorable and less damaging to it, obeying the principles of respect for the sick, human integrity , preservation of health and of course the law. However, health professionals are subject to unpleasant situations represented by civil, administrative or criminal charges in error or malpractice. For this and much more, really tarnishes the legal medical practice and in many cases unjustified errors that are ignored; and threatening the integrity and life of the patient which consequently causes damage. (173)
The exercise of medical practice should be assumed responsibilities in building ethical values and professional and institutional commitment.
In developed countries, despite the great technology doctors say, which is often compelled to follow the patient to unnecessary and unjustified initiate further studies, fearing to face a possible lawsuit. Sometimes doctors can fall into the paranoia and even get to see patients and their representatives as enemies given the existence of a potential conflict, which further deteriorates the doctor-patient relationship. (174)
MEDICAL narcissism. The DOCTOR´S dangerous ego
The narcissistic personality disorder is defined by the manual of psychiatry DSM-IV as an immense sense of self-importance, requiring excessive admiration and lack of empathy, analyzing this maybe the medicine would be the "ideal job" for the satisfaction narcissist. The narcissist suffers from low self-esteem, but like to draw attention to counter their sense of inferiority, its prevalence is higher in men than in women, which include feelings of grandiosity, superiority, egoism and who think only of themselves. The extreme form of narcissism is called "perverse narcissism" which consists of the satisfaction of wants and needs at the expense of the other. (175)
There are doctors who take risks, more to demonstrate their expertise by a real need of the patient, they may be pressured by commercial, corporate and labor issues saturation. The doctor narcissism is characterized by focus more on the disease in the patient. One doctor-patient relationship where the first control everything in order to avoid anxiety and discomfort as a mechanism of self-protection is established. The most typical features of medical narcissism are feelings of superiority, authority, perfection, self-admiration and arrogance. (176)
The boundary between "healthy" narcissism and "pathological" would be a healthy self-esteem, while pathological narcissism would be arrogant attitude of "smarty" and have total control, the doctor never hesitates or shows his mistakes and fears and always it acts as if everything was fine. (177)
Within the psychological dynamics of narcissism, the "I" is idealized, even by patients who see a doctor as a powerful healer. While the patient is often reduced to a number of "bed" or a "history" virtually disappears as a person.
The doctor-patient relationship in these cases becomes asymmetric, narcissism interferes with the doctor-patient relationship, the doctor is the almighty and the patient is weak. The word "sick" comes from the Latin "in firmus" which means "to be weak", and when individuals lose their north in relation to the other and it is thought that the most important is what corresponds to the "I" is impossible to establish an adequate bond; as the "other" (in this case the patient) is the basis of moral existence. If the other is not considered as a person, as an individual and as a human, our moral disappears; meanwhile, scientific medicine tends to treat human necessarily measurable object while transforming it into an object, medicine is dehumanized. (178)
You should look for changes in the healthcare system and proposals in the academic sector to avoid narcissism. It is shown, that is precisely the lack of communication between doctor and patient or family, the reason for over 95% of applications in the medical field. (179)
Also, easy access to information which today have patients and users of the health system either over the Internet or the press does not help to balance the doctor-patient relationship, if it is true that patients can provide information this can be dangerous in the long run because they can even come to believe by their own narcissism, which are able to replace the doctor.
LUCIFER EFFECT. THE GOOD AND BAD DOCTORS
Inside the mind and acting of human beings, we have the "free will", which gives us the power to decide between doing good or evil. It has been investigated how the placing people in place can adversely affect their behavior, because the environment can eventually change the way we behave. The individual carries cultural qualities, psychological and individual and own intellectual that characterize and differentiate them from others. Immersed within a complex social structure, full of social and economic demands as well as temptations and difficulties, their behavior often must "fit" within certain conventions. (180)
In this sense, the work of Professor Philip Zimbardo, which was written in 2008 entitled whose fundamental thesis "The Lucifer Effect" is the theory of "how good people can become in bad people" outlined Professor Zimbardo tried to discover the origin of the evil, based on his long personal and professional experience as a social psychologist, taking for this experiment Stanford Prison by behavioral observation of prisoners and jailers. In this experiment, he examined several triggers of evil, as the "blind obedience to authority" (abuses of teachers, parents and all those who exercise power), determined that it can placate or demoralize someone with words and identified as anonymous, he plays a crucial role in the harmful conduct and protecting the identity of the sadistic individual acting as a mask, and this; you feel free, powerful and protected to act and continue their work. The "seed of evil" takes place in our brains when we dehumanize, we attack or not we avoid that a heinous act, a crime punishable committed or something and it seems that is anatomically located in the limbic area of the brain. Some people do not test well with whom they associate, and when people commit reprehensible acts regardless of their future consequences thinking only of the present danger to repeat these actions run.
Zimbardo´s written by one of the points made is conclusive modify or withdraw the objectionable conduct by a group of people or requires factors such as strength, determination, virtue and vulnerability that contribute to a given situation also signals the loss of the sense of individuality subjects suffering when they are immersed in certain social groups that stigmatize, hauling result in a change in behavior, can a blind and irrational obedience to authority occur, passivity against the threat higher or others, self-righteousness by which the individual is convinced that he is right, but what you are doing is considered an outburst in the eyes of humanity itself. Rationalization, defense mechanism is to justify the actions (usually themselves)
in order to avoid censorship trying to give a "logical explanation" to the feelings, thoughts or behaviors that otherwise would cause anxiety attacks, inferiority or guilt. Before a despotic, cruel, unhealthy, the best person in the world authoritarian environment; you can become a murderer. Described above can happen to the doctor or health team when an error, iatrogenic or malpractice is committed and is justifying evade responsibility, hence the similarity with the thesis developed in "The Lucifer Effect". (181)
Given the disturbing transformation of the behavior in the "good" to "bad people" people considered, Professor Zimbardo suggests a possible antidote the heroism.
Worth mentioning, that medicine is a discipline that necessarily uses human interaction, today is the critical and even it has been discredited by its tendency to mercantilism and dehumanization. Given these strong criticism, he tries to rescue his good image based on the fundamental pillars of a "medical heroism" in order to put a limit to the ruthless and often, unfair attacks. This campaign for the virtuous and ideal medical practice exercise is supposed collaborate in the significant decrease of bad medicine. (182)
The profile of this man, virtuous and heroic doctor, should include the ability to self-analysis, concern for acquiring a high level of professional training, great responsibility, selflessness and sense of duty, ability to overcome your own ego for the benefit of health patient humbly recognize the limitations of their field of action, promote and require the authorities to regular and systematic implementation of panel discussions of cases of errors, iatrogenic, dyspraxia and medical malpractice, seeking to amend faults and optimize the medical act avoid being punitive or slanderous and promoting education aimed at updating treatments and constant observation and reminder ethical considerations and the laws governing the conduct and daily work of medical professional.
OmertÁ POLICY IN THE HEALTH CENTERS:
“When silence is imposed as a duty”
The "omertá" or "law of silence" is an Italian term of uncertain origin, dating back from 1800 whose origin is related to the Latin word humilitas (humility), which would be modified by dialectally "umirtá". Omertá is a code of honor in ancient Sicilian mafia that prevents give information on the activities of the organization or staff of the same to third parties. The violation of this principle is punishable by death, including reprisals are less burdensome extortion, blackmail, threats to the family, and damage the reputation and career; The spanish proverb says: "The dirty laundry is washed at home". (183)
The pacts of silence well be explicit or tacit exist in many organizations and the health sector is no exception to this, often they serve to cover up crimes and criminals. Those subject to "pacts of silence" do not often see, hear or say anything, omertá is essential for companies with illegal or unethical activities; so that maintaining the secrecy of the proceedings prevent public opinion, civil or criminal justice interfere.(184)
DISCUSSION OF MEDICAL ERRORS AND ADVERSE EVENTS
"The error is a weapon that always ends up fired against which employs". Concepción Arenal.
In medicine incorporating the recognition of medical errors it has been slow, as it encompasses both health professionals and the public and private systems. In some countries like the US, conferences impact on morbidity and mortality caused by medical errors are made. (185)
Consequently, discussing errors is a goal to learn from them and prevent them openly comment on the occurrence of errors can be more alert and provide better quality health care, and provide patient satisfaction. Similarly, the existence of failures in the health system must be improved or corrected.(186)
Should DOCTORS DISCUSS THE ERROR WITH THE PATIENT ?
There are many factors that can inhibit the medical professional to report a medical error ranging from fear, fear of damaging their reputation and many other situations that may be uncomfortable. However, reveal an error and take appropriate measures may prevent continue to commit, and conversely, to hide the fact, deterioration of trust between doctor and patient and exacerbates their commission. (187)
Then point out some attitudes of both physicians and patients according to Gallagher, Garbutt and Waterman, which identified three areas 1) What are the attitudes of patients in relation to the commission of errors by doctors ?. 2) Should doctors discuss with patients or reveal committing an error? 3) What are the emotional needs of patients and physicians when a medical error occurs and what should be the solutions to be found? (188)
Among the most frequent causes of medical complaints of delays in care for the sick, and errors in diagnosis, the fatal consequences of performing diagnostic and therapeutic procedures, application of wrong behaviors or incomplete treatments mentioned (partial tumor resection). In the United States (US), it is almost a custom sue for medical malpractice for various reasons such as high fees charged by doctors, the loss of the doctor-patient relationship, the existence of malpractice insurance and attitude lawyers. (172)
TRIAL AND MEDICAL LEGAL ALLEGATIONS
“Fiat iustitia et ruat caelum”. Latin aphorism
Today, the patient is aware that he can sue the doctor if you are not happy or satisfied with the result, patients are demanding more humane care while specialists complain of lack of time and resources. The "trial industry" in the health field, far from diminishing advancing at a dizzying pace that is good for nothing but smother the moral and economic health system of a country. In Spain, 50,000 annual malpractice complaints are recorded, according to the Patient Ombudsman, 60% more than 10 years ago.
There are times when the doctor often confronted with the dilemma of what to do for the good of the patient, and what the likely actions is more favorable and less damaging to it, obeying the principles of respect for the sick, human integrity , preservation of health and of course the law. However, health professionals are subject to unpleasant situations represented by civil, administrative or criminal charges in error or malpractice. For this and much more, really tarnishes the legal medical practice and in many cases unjustified errors that are ignored; and threatening the integrity and life of the patient which consequently causes damage. (173)
The exercise of medical practice should be assumed responsibilities in building ethical values and professional and institutional commitment.
In developed countries, despite the great technology doctors say, which is often compelled to follow the patient to unnecessary and unjustified initiate further studies, fearing to face a possible lawsuit. Sometimes doctors can fall into the paranoia and even get to see patients and their representatives as enemies given the existence of a potential conflict, which further deteriorates the doctor-patient relationship. (174)
MEDICAL narcissism. The DOCTOR´S dangerous ego
The narcissistic personality disorder is defined by the manual of psychiatry DSM-IV as an immense sense of self-importance, requiring excessive admiration and lack of empathy, analyzing this maybe the medicine would be the "ideal job" for the satisfaction narcissist. The narcissist suffers from low self-esteem, but like to draw attention to counter their sense of inferiority, its prevalence is higher in men than in women, which include feelings of grandiosity, superiority, egoism and who think only of themselves. The extreme form of narcissism is called "perverse narcissism" which consists of the satisfaction of wants and needs at the expense of the other. (175)
There are doctors who take risks, more to demonstrate their expertise by a real need of the patient, they may be pressured by commercial, corporate and labor issues saturation. The doctor narcissism is characterized by focus more on the disease in the patient. One doctor-patient relationship where the first control everything in order to avoid anxiety and discomfort as a mechanism of self-protection is established. The most typical features of medical narcissism are feelings of superiority, authority, perfection, self-admiration and arrogance. (176)
The boundary between "healthy" narcissism and "pathological" would be a healthy self-esteem, while pathological narcissism would be arrogant attitude of "smarty" and have total control, the doctor never hesitates or shows his mistakes and fears and always it acts as if everything was fine. (177)
Within the psychological dynamics of narcissism, the "I" is idealized, even by patients who see a doctor as a powerful healer. While the patient is often reduced to a number of "bed" or a "history" virtually disappears as a person.
The doctor-patient relationship in these cases becomes asymmetric, narcissism interferes with the doctor-patient relationship, the doctor is the almighty and the patient is weak. The word "sick" comes from the Latin "in firmus" which means "to be weak", and when individuals lose their north in relation to the other and it is thought that the most important is what corresponds to the "I" is impossible to establish an adequate bond; as the "other" (in this case the patient) is the basis of moral existence. If the other is not considered as a person, as an individual and as a human, our moral disappears; meanwhile, scientific medicine tends to treat human necessarily measurable object while transforming it into an object, medicine is dehumanized. (178)
You should look for changes in the healthcare system and proposals in the academic sector to avoid narcissism. It is shown, that is precisely the lack of communication between doctor and patient or family, the reason for over 95% of applications in the medical field. (179)
Also, easy access to information which today have patients and users of the health system either over the Internet or the press does not help to balance the doctor-patient relationship, if it is true that patients can provide information this can be dangerous in the long run because they can even come to believe by their own narcissism, which are able to replace the doctor.
LUCIFER EFFECT. THE GOOD AND BAD DOCTORS
Inside the mind and acting of human beings, we have the "free will", which gives us the power to decide between doing good or evil. It has been investigated how the placing people in place can adversely affect their behavior, because the environment can eventually change the way we behave. The individual carries cultural qualities, psychological and individual and own intellectual that characterize and differentiate them from others. Immersed within a complex social structure, full of social and economic demands as well as temptations and difficulties, their behavior often must "fit" within certain conventions. (180)
In this sense, the work of Professor Philip Zimbardo, which was written in 2008 entitled whose fundamental thesis "The Lucifer Effect" is the theory of "how good people can become in bad people" outlined Professor Zimbardo tried to discover the origin of the evil, based on his long personal and professional experience as a social psychologist, taking for this experiment Stanford Prison by behavioral observation of prisoners and jailers. In this experiment, he examined several triggers of evil, as the "blind obedience to authority" (abuses of teachers, parents and all those who exercise power), determined that it can placate or demoralize someone with words and identified as anonymous, he plays a crucial role in the harmful conduct and protecting the identity of the sadistic individual acting as a mask, and this; you feel free, powerful and protected to act and continue their work. The "seed of evil" takes place in our brains when we dehumanize, we attack or not we avoid that a heinous act, a crime punishable committed or something and it seems that is anatomically located in the limbic area of the brain. Some people do not test well with whom they associate, and when people commit reprehensible acts regardless of their future consequences thinking only of the present danger to repeat these actions run.
Zimbardo´s written by one of the points made is conclusive modify or withdraw the objectionable conduct by a group of people or requires factors such as strength, determination, virtue and vulnerability that contribute to a given situation also signals the loss of the sense of individuality subjects suffering when they are immersed in certain social groups that stigmatize, hauling result in a change in behavior, can a blind and irrational obedience to authority occur, passivity against the threat higher or others, self-righteousness by which the individual is convinced that he is right, but what you are doing is considered an outburst in the eyes of humanity itself. Rationalization, defense mechanism is to justify the actions (usually themselves)
Given the disturbing transformation of the behavior in the "good" to "bad people" people considered, Professor Zimbardo suggests a possible antidote the heroism.
Worth mentioning, that medicine is a discipline that necessarily uses human interaction, today is the critical and even it has been discredited by its tendency to mercantilism and dehumanization. Given these strong criticism, he tries to rescue his good image based on the fundamental pillars of a "medical heroism" in order to put a limit to the ruthless and often, unfair attacks. This campaign for the virtuous and ideal medical practice exercise is supposed collaborate in the significant decrease of bad medicine. (182)
The profile of this man, virtuous and heroic doctor, should include the ability to self-analysis, concern for acquiring a high level of professional training, great responsibility, selflessness and sense of duty, ability to overcome your own ego for the benefit of health patient humbly recognize the limitations of their field of action, promote and require the authorities to regular and systematic implementation of panel discussions of cases of errors, iatrogenic, dyspraxia and medical malpractice, seeking to amend faults and optimize the medical act avoid being punitive or slanderous and promoting education aimed at updating treatments and constant observation and reminder ethical considerations and the laws governing the conduct and daily work of medical professional.
OmertÁ POLICY IN THE HEALTH CENTERS:
“When silence is imposed as a duty”
The "omertá" or "law of silence" is an Italian term of uncertain origin, dating back from 1800 whose origin is related to the Latin word humilitas (humility), which would be modified by dialectally "umirtá". Omertá is a code of honor in ancient Sicilian mafia that prevents give information on the activities of the organization or staff of the same to third parties. The violation of this principle is punishable by death, including reprisals are less burdensome extortion, blackmail, threats to the family, and damage the reputation and career; The spanish proverb says: "The dirty laundry is washed at home". (183)
The pacts of silence well be explicit or tacit exist in many organizations and the health sector is no exception to this, often they serve to cover up crimes and criminals. Those subject to "pacts of silence" do not often see, hear or say anything, omertá is essential for companies with illegal or unethical activities; so that maintaining the secrecy of the proceedings prevent public opinion, civil or criminal justice interfere.(184)
DISCUSSION OF MEDICAL ERRORS AND ADVERSE EVENTS
"The error is a weapon that always ends up fired against which employs". Concepción Arenal.
In medicine incorporating the recognition of medical errors it has been slow, as it encompasses both health professionals and the public and private systems. In some countries like the US, conferences impact on morbidity and mortality caused by medical errors are made. (185)
Consequently, discussing errors is a goal to learn from them and prevent them openly comment on the occurrence of errors can be more alert and provide better quality health care, and provide patient satisfaction. Similarly, the existence of failures in the health system must be improved or corrected.(186)
Should DOCTORS DISCUSS THE ERROR WITH THE PATIENT ?
There are many factors that can inhibit the medical professional to report a medical error ranging from fear, fear of damaging their reputation and many other situations that may be uncomfortable. However, reveal an error and take appropriate measures may prevent continue to commit, and conversely, to hide the fact, deterioration of trust between doctor and patient and exacerbates their commission. (187)
Then point out some attitudes of both physicians and patients according to Gallagher, Garbutt and Waterman, which identified three areas 1) What are the attitudes of patients in relation to the commission of errors by doctors ?. 2) Should doctors discuss with patients or reveal committing an error? 3) What are the emotional needs of patients and physicians when a medical error occurs and what should be the solutions to be found? (188)