April 19, 2011
The president-elect of the American College of Surgeons stepped down amid controversy over a sexist Valentines Day editorial published touting beneficial effects of semen (and unprotected sex) on women’s moods. Though not directly harmful to any patients, his editorial was viewed by many as being a continuation the disruptive behavior of a “good ol’ boy’s club” that is disrespectful and intolerant of women. The field of surgery, in particular, has stereotypically been seen as men’s field, and female surgeons have often faced very difficult times during their training. This has, of course, improved over the years, but apparently not enough. The legal and cultural aspects of the working environment – – including the hospital and the OR – – have evolved in the past couple decades; what once was considered a harmless joke is now increasingly recognized as being distasteful, intolerant and abusive.
April 14, 2011
Not long ago, the Chicago Tribune ran a controversial article about the how the Illinois Professional Health Program handles confidential information. Their slant on the issue was that the Program was essentially harboring criminals by keeping secrets that could harm the public. Interestingly, several years ago, the Maryland State Board of Physician Quality Assurance (BPQA) was disbanded after being criticized for being “too physician-friendly” and subsequently the Board of Physicians was established with a renewed perspective on their primary mission: to protect the public.
Clearly those working with impaired, distressed and disruptive physicians have struggled with “how confidential” information should be regarding their physician patients. On the one hand we appreciate the need for the public to be warned of potentially dangerous docs. But on the other hand, for our corrective and therapeutic work to have any chances of being effective, our patients (those, so-called, dangerous docs) have to have some assurance that what they discuss with us in remedial coaching, tutoring or therapy has some protection from others’ eyes and ears. There needs to be a delicate balancing act whereby these often-competing needs are fully appreciated, discussed at the start of intervention and are repeatedly revisited by all parties involved. When working in these types of situations, there are essentially two primary clients: the professional in my office and the referring agency (usually a licensing board, professional society, hospital, etc) who at some level represent the interests of the public. When a treating clinician (or program) loses sight of this, problems arise.
April 8, 2011
We’ve all heard about so-called “zero-tolerance” policies. They sound great and seem like they make a lot of sense, but if you think about it, can you really apply such concrete decision making to dealing with human behavior?
In this Washington Post article some “myths” about zero-tolerance policies are exposed. This article was written primarily about the application of such policies in the school setting, I think it touched on many common themes that I deal with when consulting to work organizations. Probably the main point I try to bring home when speaking with a policy maker (or policy implementer) is that “zero-tolerance” does not mean “termination.” It simply means that the organization will not tolerate the identified behavior and it will take some sort of action against the employee, perhaps including risk assessment evaluation, discipline, education, demotion, etc. Of course termination is still an option in these cases, but it is not the only option.
April 4, 2011
Some recent research indicates that though there are some notable cognitive declines (primarily in memory and processing speed) following early adulthood, the impact of these declines are not all that significant. We often harshly judge our our memory skills and do so in a manner that is simply not very accurate. In fact, some studies are suggesting that despite these memory slips and cognitive slowing, our critical thinking, judgment and decision making improve so significantly with age (and experience) that it compensates for the cognitive losses. An example given was a study that compared reaction times of young pilots to more senior pilots: the younger pilots responded more quickly in simulation practices, but the senior pilots crashed less often.