Blacklisting/None-Listing Patients

Expectations influence perception.

Ever try to get iatrogenic injuries diagnosed and treated? Good luck. Want to see a demonstration of why? Just show this page, or communicate the information on it, to anyone in medicine. Note the response.

Disbelief. Dismissal. Denial. Animosity for the person who wrote it. Just for talking about it. Iatrogenic injuries are injuries incurred in medicine. Medicine dismisses them as "frivolous" even when a single patient sits before them asking for help. Those health care professionals do not believe the patient has injuries that are iatrogenic, but does believe pejoritive things about that patient that end up in the record instead of accurate diagnoses.

Heath care workers hearing about the subject written on this page tend to dismiss it all as sweeping generalizations and unfounded assertions. During the decade during which I wrote this I was contacted by thousands of injured patients who were desperately searching for anyone who would help them (I got 30 or 40 calls a week for years. Just 10 patients a week for 10 years would have been 5,000, so "thousands" is a conservative way to express it).

The injured patients wanted to send me all their records. They wanted to tell me every detail of what had injured them and what they had been through since. Eventually I had to make myself harder to contact. I was spending far too much time speaking to injured patients on the phone. My goal was to prevent future patients from getting injured in the first place. I needed the time to work on that.

What the injured patients experienced in medicine was disbelief, dismissal, denial and animosity mentioned above. To get help after getting injured in medicine patients have no choice but to go to the same group that got laws passed to prevent lawsuits being filed by patients because that group believes that the injuries all are frivolous.

When you arrive needing care for an iatrogenic injury the knee-jerk reaction of health care is to not believe you. But even if they do, there are more reasons working against your getting help.

For one thing, there won't be any record of how you got injured. Ask a few hundred injured patients to get their records and see. I asked thousands. Injured patients are surprised. They had faith in their treatment providers to be lucid and honest. If their treatment providers were lucid and honest they at least would be aware that they almost never make a record of it when things go wrong in medicine. If not from their own experience then from all of the studies showing that. But they disbelieve those studies and dismiss them just like they do this page and the injured patients who come to them for help.

The injured patients also were surprised when the treatment provider who caused the injury branded them as "difficult" or worse and spread lies about them. Getting injured in medicine leads to a long learning curve for a patient.

Another reason treatment providers do this to patients is that it can damage the career of a health care professional to diagnose iatrogenic injuries because the rest of the medical community will turn on him or her for doing that. And "you can't let one patient ruin your whole career" is a mantra in medicine.

There are more reasons beyond those, but the point is that patients who have been injured by their treatment providers are treated differently than other patients.

As Nate Silver says, in the book at left, we unconsciously let biases based on expectation or self-interest affect our analysis.

Doctors are not supposed to be critical of other doctors. That is a matter of law some places. It is both an unwritten and a written law. If they violate it, their own careers can be hurt - a highly influential self-interest that gets little recognition in a culture that is in denial about the extent to which it is self-interested (for instance, see Dr. Lars Aanning who had his license revoked for admitting he lied to protect other physicians).

Self Interest

What health care providers are willing to believe is strongly effected by what result those beliefs will have on themselves and their profession as a whole. They are better off imagining that all those injured patients are frivolous cranks. Imagining that not only insulates their self-images from uncomfortable realities, but also enables them to do things that would seem wrong when not imagining themselves or their group to be under attack.

Anyone helping injured patients is considered to be someone who is attacking them? The description written here to help injured patients understand that they are not alone is an attack on medicine? Helping patients to understand what the problem is so that they might better deal with it is an attack on medicine?

Injured patients have a knee jerk reaction to their being vilified and sidelined by medicine after being injured. They want to pass laws to prevent this from happening to other patients. Part of what is necessary for anything productive to result from such efforts is an understanding of why passing laws is unlikely to help. Imagining that it would largely is a failure to understand the problem.

They don't believe they injure patients

You could be excused for thinking that since they caused the injuries to the patient that the patient they injured would be their next patient. But if you speak to enough of them about the injured patients, you discover that they do not think that way.

What makes sense to them is defense and denial. What doesn't make sense to them they don't write down. When injured patients submit themselves for treatment for the injuries to physicians who don't believe what the patients report, no record is made of it.

Actually, if they do believe it they probably are even less likely to make a record of it ( see loyalty). If they feel the need to note something about why the patient was there, they may ask a series of questions, or perhaps the same question in a series of different ways, until an answer is given that they are comfortable writing down.

"When did you first notice the symptom?"

"How long after the operation was it before you THOUGHT you noticed this?"

you noticed this?" "Was there ever a time prior to this when you had a similar symptom?"

"Have you ever had an accident or sports injury or illness that produced a similar symptom?"

It is a cross examination fishing for any piece of information that can be used to reject the patient's claim. If twenty questions do not do that, but the twenty-first can be repeated out of context in a way that will seem to, that can get written in the record.

Living in a fictitious world built on a denial of facts.

If they never get an answer they want to put in the record, they still aren't likely to record any of the ones that they don't like. The patient probably will be asked if he/she has been back to see the surgeon (or whoever injured the patient). If not, that is the course of action that sometimes is recommended in order to end the appointment.

Any real attempt to examine the patient will be unlikely, in part because no one in medicine wants to verify injuries that could be used to indict someone else in medicine, and in part because no one in medicine wants to get dragged into court to testify. If the patient has been back to the surgeon (or whomever) already, the doctor usually will ask what the surgeon said, and it almost doesn’t matter what the patient reports about that. The doctor will agree, often by saying something like "Well, that surgeon has a very fine reputation and I’m confident that he/she knows what he/she is talking about." But no real exam, and no record of the patient’s claim. Even if the patient is poked and prodded, even if a CT scan is done because the patient demanded it. When these things are done by people who do not want to find injuries, they don't.

Sunshine can deprive bad actors of the secrecy needed to act badly

When a doctor, either the one who caused the injuries or one of the ones applied to for help, labels the patient as crazy and telegraphs that to other doctors, along with the notion that this patient could harm a colleague, a received view emerges in the medical community to which all others unthinkingly conform. They don't recognize their own self-interested cloud of clichés, false assumptions and lies as they turn the white wall of silence into into a blacklist (aka none-list) with nothing more than a phone call or a nuance in a referral negatively branding the injured patient. This isn't just remaining silent. This is going further and spreading the word to make sure others do too.

If you groped a patient, how likely would you be to make that transparent?

Interestingly, when they no longer can deny that a colleague was, for instance, a serial killer, health care professionals who are asked why they don't report colleagues who are murdering patients sometimes say things like that they didn't because the system lacks a way to spread the word, as they said with Charles Cullen. But when the problem is the fact that the reputation of another health care professional could be blemished, they find lots of ways to spread words to prevent that.

A surreal level of honesty

Physicians assume a level of honesty from their peers that is beyond what reasonably can be expected from human beings. They do not anticipate the obfuscation of having caused injuries to patients. Apparently they imagine that those who injure patients, either accidentally or on purpose, will write in the record that they did that. Apparently it is imagined that others in medicine will not rationalize why they shouldn't, or even rationalize enough to imagine that they themselves didn't do anything wrong. Apparently health care professionals have so much faith in each other as for it to be unimaginable that any colleague would vilify a patient to make the patient appear to be the problem.

The standard behavior is to not write in the record that there are injuries. Fish swim. Birds fly. Treatment providers deny. Just listen to any who read this page.

A patient arriving claiming to have been injured by another health care professional cannot get the next one to make such a record either. Instead, the patient gets regarded as a crazy person who potentially could ruin the career of an innocent colleague. When most injured patients are treated differently than all other patients, isn't that profiling? And in what way does that produce a different result than blacklisting (aka none-listing)?

Institutional Blindness

There also can be the influence some have called institutional blindness. Like if you went to the police, to report that while you were away some of your possessions had been stolen, the only thing the police would know for sure is that you are reporting that you cannot find some of your possessions. They do not know who else has keys to your home or what else might account for the possessions being missing and so write down only what they know, that you are reporting possessions being missing. Medical records written in this way at least would record that you have complaints and believe you have been injured, even if they do not record the who, what and where of what you have reported.

However, when medicine will not even acknowledge that there are injuries, it goes beyond mere blindness. Routinely, patients seeking medical help are asked how they got injured and, if they answer that someone else in medicine caused it, open up a world of mendacity and manipulation that further injures them. If they look at their records later they can find fanciful, if not pejorative, statements claiming the patient reported the opposite of what the patient actually reported. Doctors lie, but believe that they don't. They believe the patient is a crank and believe other treatment providers need to be warned and protected.

C43.4

C43.4 is one of the diagnosis codes that could appear in your record after trying to get treatment for an iatrogenic injury. It is part of the the International Classification of Diseases, Tenth Revision (ICD-10) which has tens of thousands of codes. You can look up the codes on the internet by searching on "ICD-10 codes" to see what the codes in your chart mean (the links to that keep changing). C43.4 is the code for "Malignant Neoplasm of the Neck," which is a supposed to identify a particular physical problem in your neck (most commonly suspicious masses and adenopathy), but also can be a way to communicate to other caregivers that you are a pain in the neck.

Trisha Torrey wrote that notations can be made in the patient's record that are as simple as PITA (pain in the ass) or GOMER (get out of my emergency room). One former health care worker reported that her office used ICD code 569.42 that indicates anal or rectal pain. Other health care workers have reported additional codes used to paint the patient as a problem.

F68.1 is the code that more transparently identifies a patient believed to be feigning symptoms or disabilities. Unfortunately, with electronic records, these diagnoses can follow patients forever. (Prior to electronic records I was able to tell patients how to get iatrogenic injuries diagnosed out of town by escaping prior records. Now the only hope for that is telemedicine to other countries. India is good place to try. Doctors anywhere can order blood work and x-rays and other diagnostic tests to be done in the USA and evaluate them for you.)

Health care professionals also can find ways to protect their careers and their belief in their profession by imagining that the patient has Somatoform disorder. In Somatoform disorder, the patient does not consciously feign symptoms (which would be known as facetious disorder) or fabricate them in order to get or achieve something (known as malingering), but actually believes he/she has real injuries. Odd when, in fact, it is the treatment providers who have the false belief that the patient who has real injuries doesn't.

There are more colloquial codes as well, ones having nothing to do with ICD-10. Like "DSB" which stands for Drug Seeking Behavior. This could lead other physicians to avoid even accepting an appointment from the patient. If they did accept the appointment, it could be an appointment during which there is no real attempt to diagnose the patient because they only are giving the patient the run-around.

It would be unethical for a physician to put a note in your chart saying,"Do not treat this patient." However, it is not illegal to note character information in your chart. (Andrew Lawrence Weitz, attorney).

Only for Patients

With all the ways to categorize patients and the ways patients think and behave, why are there none for treatment providers? The word "misdiagnosis" is simple and innocent, but why is there no code for it in order to get future diagnoses on the right track? Why is there no code to identify when a patient was put on a certain prescription because that is what a certain treatment provider puts almost all patients on. Some providers first response frequently is psychopharmacuetical? There are surgeons who routinely move patients to surgery after the first appointment in a field where others routinely recommend physical therapy. Especially when that surgeon is known to brag about that to other surgeons? (Another actual case and reason for why patients need access to data collected about the outcomes and experiences of the patient community in order to be able to make decisions informed by honest information that they never will get from treatment providers).

There needs to be labels for the differences in the way treatment providers treat. A peer reviewed study of a specific treatment is helpful, but irrelevant in the hands of the wrong treatment provider. Some routinely harm patients. If there is no code for the problems caused by providers, these issues will not become part of what is understood about a patient's condition. It will be that much more difficult to understand how to help the patient. When the causes of the problems cannot be diagnosed, how can they be healed? Or how can the patient community at least become less unwitting?

Misdiagnosis Codes

What would be the correct diagnosis code to describe the originator of the falsehoods that were recorded to cover up injuring patient after patient? What would be the one to describe all of the caregivers who uncritically fell in line with the lies that covered it up and by so doing enforced that label as the only history on the matter?

How can you solve a problem that you cannot correctly diagnose and label?

A more Sinister Darkness

People who are victims of natural disasters, like hurricanes and earthquakes, usually can overcome having psychological baggage weigh them down for long afterwards. People who are victims of disasters caused by humans, like the Exxon Valdez, have a higher rate of mental trauma. But at least that was an accident.

People who are victims of injuries incurred in medicine suffer more. Especially when the injuries were caused intentionally. And is there any other way to describe the injuries caused by not getting care for the original injuries when health care professionals will not diagnose let alone treat them?

Treating patients as though they are the enemy

What do we call the injuries caused by being surrounded by a community that is determined to make it appear as though the problem is the patient. That is the special form of mobbing and bullying reserved by the community of health care professionals for patients.

How can this be described as anything other than health care professionals conspiring to injure the victim in order to protect reputations and/or careers and/or their belief in their own malarkey? What would be the label for that?

Somatoform Diagnosis?

Whatever the label, patients cannot get even recognition of their injuries, let alone treatment, because caregivers have such a strong need to disbelieve in the injuries (like they disbelieve what is written about them here). There is no place those patients can go to find an advocate who honestly has their interests at heart. Can the situation that has been created for patients be called anything short of evil? It is an accurate description of what commonly happens to injured patients.

It is not uncommon for people never to recover from having a group of other people singling them out for unjust, and sometimes life-ruining, treatment.

Do you think you can find anyone in medicine who even is aware of having done that? The mental gymnastics they do to arrange their beliefs in ways that leave themselves feeling righteous are disturbing to behold.

Culture

One of the ways they do this is with theories and learned articles about how to create a "culture of safety" or a "culture rich in reporting" or a "culture of respect" (for instance, this article by Leape). I've written more about that on this site at Silence VS Safety.

What medicine really has is a "culture of collusion and cover-up" about which they are defensive, protective and in denial. It is one of the features of our health care system that is so firmly entrenched that it is not recognized. The beliefs, habits and self-interests that create it are the norm. They even write articles about how being less critical of the care of other physicians would be better for patients. And how forming "huddles" on a regular basis to create agreement on the "facts" will make medicine safer for patients, without any sense of the ways in which those practices can be used to do just the opposite in a world where providers stay focused on processes, instead of outcomes, and patients can get no reliable information that would enable them to be a check on the problems created by that.

And those are the only people to whom injured patients can turn for help.

Caregivers need only be on the same page.

Patients need mechanisms that can help them protect themselves when their caregivers turn on them.

Blacklisting (aka none-listing) is mischaracterized by the medical community in order to deny its existence in their own minds as well as in the public's. They dismiss it as though blacklisting required a physical list being passed around. It can happen with no communication between physicians at all, as long as they are on the same page, as though they had a list.

Since they always will find self-interested ways to define blacklisting in order to deny its reality, we should put a different label on how it is done in medicine. It is done without a written list. It is done without passing around information about specific individuals. It is the agreement to treat none of the patients who present themselves as having iatrogenic injuries. It is not a positive, as with a list positively identifying certain people for certain behavior. It is a negative, an agreement that none of the people matching a certain profile will be treated. We could call it a None-List.

Being surrounded by others who share your perspective is a powerful reinforcement

None of the people in medicine I've spoken think that blacklisting is an issue. For them, it isn't. It is not happening to them. So they never are going to pay attention to it, let alone fix it. If the well being of patients were their first priority, they would. But it's not. And their perspective is too self-serving to see that. Injured patients need someone with a different perspective.

"Every doctor will allow a colleague to decimate a whole countryside sooner than violate the bond of professional etiquette by giving him away." - George Bernard Shaw

It's nothing new. Fortunately, it can become a thing of the past, if the patient community stops repeating what it always has done in the past, which mainly is imagine that health care professionals and/or the government can fix this (like by passing a law).

Note from a patient: "I can’t thank you enough for . . . your web site. . . As I read the sections on the Wall of Silence and Blacklisting I felt like I was reading the story of my life."

More on Blacklisting/None-listing->

All that is necessary for speech to be libel or slander or defamation is for one party to say something untrue to another party and have that second party believe it. It does not have to be widely broadcast. When the health care professional who injured the patient tells lies about the patient to other health care professionals in order to protect him or herself, why is there never a suit brought for defamation? Patients get sued for telling other patients. No one in medicine does.

It can cause additional physical injuries when patients cannot get treatment for the original injuries.

There is an interesting case when a patient sued, on another site, when OR staff spoke pejoritively about him while he was unconscious. Patients need to be more aware of how much the caregiving community often dislikes them and how that can effect their care. Sometimes they dislike patients enough to intentionally injure them (do I really need to list examples here - just start with a search on serial killers in medicine and work your way down).