How To Kill Patients and Get Away With It

The feeling of moral responsibility is inversely proportional to the distance between the moral agent and the point of responsibility.

The closer the point of responsibility, the greater the feeling of responsibility.

To illustrate: it’s easier to blow the face off of a toddler by passive consent to war when she’s 6,000 miles away than 30 feet in front of you. Why? It’s much easier to justify the killing when the toddler has no face to begin with in your mind’s eye.

This is why banality is so evil – if you don’t feel a sense of responsibility, it’s harder to step up. You feel no reason.

With that, let’s explore how our healthcare institutions, ideologies, practices, providers, FDA, HIPAA, information systems and vendors can continue to kill patients…and get away with it.

  • Design facilities that maximize interruption of providers
  • Replace creative revenue strategies with cost-cutting tactics
  • Make it as difficult as possible to connect and aggregate patient information for optimal decision-making in light of risk – paper records are highly recommended for this
  • Building on the previous tip: Justify the continued use of paper records based solely on the lack of safe and effective information systems in your experience
  • Increase patient-to-nurse ratios – this is very easy to do and boosts quarterly earnings. Bonus tip: don’t re-invest the earnings – cut a dividend, reward senior management.
  • Hire and promote management talent with no experience in clinical operations whatsoever
  • Design information systems that make interpretation as flawed as possible – anything that requires the re-wiring of trillions of neurons to find and make sense of clinical data is a good start
  • Force physicians to follow rules that make no sense and place the institution’s interests and regulatory mindlessness above all else
  • Develop FDA regulations that require every bit of data about a pharmaceutical product to be placed in a package insert. A picture of a molecule is worth a thousand words of irrelevance
  • Building on the previous tip: make sure that there’s nothing meaningful a patient can take away from the insert
  • Building the previous tip even higher: make sure that the insert confuses patients so much that they  completely give up on questioning what they’re taking
  • Give different medications like-sounding names
  • Conduct clinical trials in poor countries without considering what effect differential population genetics have on pharmacokinetics and pharmacodynamics
  • Legislate privacy laws, like HIPAA, without considering the consequences. Let the Law of Unintended Consequences reign over Forethought
  • Don’t question well-established medical assumptions and practices
  • Don’t do anything to change clinical environments of blame, anger and passive-aggressive behavior
  • Maintain high rates of facility-acquired infection by treating the janitorial staff like dregs of society
  • Over-prescribe antibiotics
  • Ask patients to ask providers to wash their hands, and then ask yourself to wash your hands of any guilt
  • Repurpose clinical documentation from a workflow process that helps providers care for patients into a weapon of defensive medicine
  • When discussing healthcare reform, use politically-charged language, vilify your opponent, don’t consider other viewpoints and – most importantly – confuse opinion for fact
  • Replace the scientific method with new-age mysticism, feel-good language and positive imagery
  • Don’t listen to the people in your care
  • Pretend to care
  • Don’t listen to nurses
  • Pretend to love nurses
  • Refuse to see that health care is a national security concern

That’s it for now – there are so many more ways to kill patients and get away with it.

If you have tips of your own, please add them in the comments.

Together, we can design Healthcare’s final solution.

There won’t be any war crimes trials. Nobody will hang us.

This post is not sarcastic.

This post is a reminder of the banality we’ve created.



0 Replies to “How To Kill Patients and Get Away With It”

  1. Also having educated nurses at the bedside msn prepared and having those with AA degrees in management making decisions for them.

  2. Phil – great post – I forget who said that every system is designed to have exactly the output that it does (may need google help;) but by not taking action to change the healthcare system, we enable the above transgressions to function as usual.

    The point of yours that particularly resonated with me was: Don’t do anything to change clinical environments of blame, anger and passive-aggressive behavior. I do believe that the majority of errors are caused by communication issues. We don’t teach nurses or assistive personnel how to be assertive when they see errors by MDs or nursing peers. We do need to change to a more just culture -so that when errors happen, we can all learn from them by early recognition, mitigation, & sharing experiences. We need to improve the ways in which we educate & activate patients so that they understand THEIR plan of care and can make truly informed decisions.

    Okay – enough for now – otherwise it will be a blog instead of a response. Those are just a couple of my thoughts – would love to hear patient perspectives & maybe an MD, RD, RPh or two.

  3. Hospitals practice of hiring as few nurses as possible and utilizing them to run the hospital. Continue to allow nurses as little time as possible for patient care and prevent the public from finding out rates of hospital acquired infections and staffing ratios. In short – continue things as they are.

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