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.