Why We Need Mandatory Snitch Policies

| Sun Oct. 7, 2012 1:54 PM EDT

Lowry Heussler asks:

Have you ever heard the term “disruptive physician”?

Why no, I haven't. Please go on:

The term “disruptive” means doing things that would get you fired on the spot if you were a less exalted person than an M.D....When analysts began looking closely at negative patient outcomes, we were all astonished to learn that disruptive physicians were firmly linked to morbidity and mortality. Put in simplest terms, if Dr. Frankenstein has a habit of verbally abusing the ICU nurse who calls him in the middle of the night about a patient who is not doing well, sooner or later that nurse’s subconscious causes her to start taking a more rosy view of the patient’s symptoms. Dr. Frankenstein arrives fresh and rested in the morning, but the patient lost too much ground over the night, and oops! there you have it, a negative patient outcome, also called “death.”

So here’s how the problem was addressed. Malpractice insurance underwriters and accrediting bodies require hospitals to have disruptive physician policies that clearly define the prohibited behavior, and to train all staff – right down to the parking-lot attendants – every year about what the policy says. What makes it work is the mandatory-snitch rule. If said parking lot attendant happens to witness a physician in violation of the policy, the incident must be reported or the attendant’s job is on the line.

It sounds ridiculous: threaten to fire the victims of an abusive bastard if they are too intimidated to stand up for themselves? But on closer inspection it functions exactly as a good policy should....

Heussler suggests that hundreds of people might be unfairly behind bars in Massachusetts because of faked drug tests that would have been prevented with a mandatory snitch rule. If, like me, you've never heard of this before, the whole thing is worth a read.

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