Chasing the Rabbit: Official Blog by Author Steven Spear

Complain to some health care professionals about broken processes, ineffective systems, failing through the cracks, and the like, and some will contend that patients have to manage their own care, responsible for interpreting advice, integrating the services of disparate specialists (often without the advantage of an electronic medical record to keep all information in the same place).  

Of course, there are basic problems with this approach.  Patients (and their families) typically lack the training to make decisions that should be made by experts and they can’t recognize that something is wrong  until it is too late.  Magnifying those handicaps, they are emotionally and physically compromised–that is why they are receiving care in the first place.  

Then there is the basic question of challenging authority, the basic intimidation factor that goes with putting someone in a white coat with a stethoscope draped around their neck.  The Yale researcher, Stanley Milgram ran a series of experiments in 1963 in which subjects were mislead to think they were assisting in an experiment.  Their “job” was to ask questions of “subjects” (really actors who were part of the study) and apply what they thought was an electric shock to “punish” a wrong answer.  Most participants “just followed orders,” applying ever larger shocks despite the cries of pain, protests, and pleadings of the actors–connected to fake electrodes–who were part of the charade.  Adam Cohen writes in the NY Times, (”Four Decades After Study, We Are Still Willing to Inflict Pain” NYTimes Dec 30, 2008) that a replication of Milgram’s study, done by Jerry Burger of Santa Clara University duplicated Milgram’s results.

Cohen runs a thread from these results to training for military and police.  There is another thread for training patients and providers.  Situational influences can do an enormous amount to suppress people’s ability to question authority precisely when it should be challenged.  This can be nurse to doctor, patient to provider, and so forth.  It becomes critical that providers be aware of this, and do what they can to reduce the silencing effect of the situation.

Related posts:

1. United Health Group Settlement and Better Role for Managed Care Organizations
2. Paul Kruman misses the point (again): Better care at less cost is the key…
3. Provider Competition Key to Health Care Reform
4. Measuring Therapeutic Effectiveness and Cost–One Part of Better Care for All
5. Spear on Bloomberg: What’s health care reform missing? Quality!