Medical School: Ethos Reform

Medical School: Ethos Reform

by Kali Miller, PhD | Sept.12, 2017 | Posted to HARBR Oct.12, 2017

Mama don’t let your babies grow up to be doctors.

“75% of med students and new doctors are on antidepressants or stimulants (or both)”.  The title of Pamela Wible MD‘s article caught my eye. I knew that CNN had reported that 25% of medical students report depression and about 1 in 10 have suicidal thoughts. As a former psychologist who had clients who were physicians and friends who went to medical school, that number sounded low to me. Dr. Wible’s numbers sound much more accurate, perhaps due to enhanced anonymity for her participants. After all, what professional is going to risk their career and livelihood by reporting having “psychiatric problems”. This could not only negatively impact medical students during training, but would then have to be reported to their boards when licensed. It’s interesting as professionals how we are trained to be HIPPA compliant, protecting our clients and patients confidentiality vigorously, while at the same time accepting that our own medical and mental health information is not protected from our boards and even some insurance panels.

The American Academy of Sleep Medicine reports that medical students are one of the most vulnerable groups when it comes to suffering from “poor sleep”. Those unfamiliar with medical school might think it is the rigorous studying and the stress of making life and death decisions that disrupts students sleep and I’m sure they’re not wrong. However, consider that in 2003 The Accreditation Council for Graduate Medical Education (ACGME) developed regulations which restricted “continuous maximum extended duty to 30 hours.” Does your mind boggle? Well thank goodness their recommendation was reduced in 2011 to 16 hours for some (not all!) medical students. In “The Danger Medical Students face when they don’t get enough Sleep” Sierra Kennedy writes that doctors who work more than 16 consecutive hours have “36% more serious medical errors than those whose scheduled work is limited to 16 consecutive hours” and “make 5X as many serious diagnostic errors.” This is certainly good information but really, isn’t the real question how many hours can an individual in a complex high stress occupation work before their cognitive ability significantly declines at all? These numbers don’t tell us what the decline in functioning was prior to the 16 hours. Are you curious what the decline was after 8 hours, or 12 or 15? If I recall correctly, in graduate school we were told that high stress professions such as physicians, police officers etc had a significant decline in the ability to make good decisions, defuse high stress situations and regulate their own emotions after 4-6 hours. And never mind learning.

The lack of sleep and the elusive search to feel sharper, faster, smarter explains the stimulants. And the use of stimulants doesn’t just include stimulant medications, which are controlled substances. Smoking and excessive caffeine intake is also rampant in the medical community. Didn’t you ever wonder why physicians, who of all people should know better, don’t. In my clinical psychology graduate program we were told that we could not even make an accurate diagnosis until our clients were sleeping 8 hour per night on a steady schedule for a month. Prior to that, our goal was primarily to assist our client in creating a healthy sleep routine for their mental as well as physical health. The research was in, sleep deprivation can cause depression, anxiety, aggression and even psychosis. Meanwhile, medical students and many physicians may have gone far beyond the hopes of best practice and are simply trying not to kill anyone in their impaired state.

Since being made privy to these facts over 25 years ago, I became convinced that forcing medical students and physicians to work with lack of, or interrupted sleep is not only unethical but should be illegal.  I think of medical school as similar to joining a cult. You feel very honored to be asked to join. You quickly realize those in power control who and what you are exposed to but believe that the reward will be well worth it. You have little or no time for extraneous relationships, including family. To succeed you must strictly adhere to prescribed reading and activities. You are often limited in when and what you can eat and told when and sometimes where you can sleep. As exhaustion mounts you are particularly susceptible to suggestion. You are told your entire future rests on your actions, your absolute perfection, but are set up again and again for failure. Sometimes your failure has lethal heart wrenching results and but you can’t talk about it. In fact, there are a lot of dirty little secrets you aren’t supposed to talk about. When the inevitable error happens you are either shamed and chastised, even cast out, or a superior covers for you. This leaves you feeling pitifully grateful, yet knowing your mutual silence is another cost of being in the cult, or profession, as the case may be.

Medical school graduates hope that once they’re licensed the depression, the medications, the cigarettes and alcohol won’t be needed any more, the memory of mistakes will be blunted by time, and somehow everything is going to be Okay. You have only to look at the low career satisfaction ranking of physicians or the Mayo Clinic study that confirms physicians have the highest suicide rate of any profession to see that all to often, this simply isn’t the case.

It is refreshing to see professionals like Pamela Wible speaking out. If nothing else students can make an informed choice regarding whether they want to pursue a career in medicine. Facts in hand and caught in the spotlight, teaching facilities have an opportunity to make wiser choices about how young physicians are trained. Physicians themselves can begin to speak up about what they have endured and rather then argue that they made it through or “It’s always been done this way” they can speak up for their own, the future of medicine in this country.

Our current model of training physicians serves neither the provider nor the client and it doesn’t take a psychologist to figure that out.

Kali Miller, Ph.D.

Read the article which inspired this one:

75% of med students are on antidepressants or stimulants (or both) by Pamela Wible, MD

 

Recognizing Rosenblum, Oregon’s Attorney General

Recognizing Rosenblum, Oregon’s Attorney General

August 26, 2017 – HARBR is a nonpartisan organization. As an organization, HARBR endorses no official categorical opinion regarding Oregon’s Attorney General, Ellen Rosenblum. HARBR does, however, have some specific concerns about her behavior as it affects the lives and professions of licensed healthcare professionals in Oregon. Ms. Rosenblum is the head of Oregon’s Department of Justice (DOJ). In this position, she is the supervisor of the DOJ Assistant Attorney Generals who prosecute Oregon licensed healthcare professionals when there are allegations of misconduct by regulatory boards. She also oversees the DOJ Assistant Attorney Generals who defend healthcare regulatory boards when licensees appeal board final orders to the Oregon Court of Appeals.

In a August 24, 2017 article published by Oregon Public Broadcasting’s Chris Lehman Ms. Rosenbaum shows herself in a manner HARBR believes will be recognizable to those who have been abused by their Oregon healthcare regulatory boards and the DOJ attorneys who represent them. The article relates to the firing and re-hiring of James R. Williams, an investigator for the Oregon DOJ.

Williams sued the Oregon DOJ and the matter was settled in arbitration. Sherwood attorney David Blair presided over the arbitration.

See article: http://www.opb.org/news/article/oregon-fired-doj-investigator-gets-job-back/

Take away quotes include:

Blair: “[The Oregon DOJ] “exacted the harshest penalty possible against a seven-year veteran of the department with a spotless record [.]”

Blair: “[T]his discipline appears to have been both inappropriate, unnecessary and clearly excessive.”

According to the OBP article: Blair writes that the agency could instead have offered additional training to Williams and other employees to help them better understand the agency’s expectations. Blair also ordered the agency to scrub any reference to the matter from Williams’ personnel file.

Rosenblum: “I am disappointed in the arbitrator’s decision and continue to feel strongly that I made the right decision to terminate Mr. Williams’ employment as a criminal investigator at the Oregon Department of Justice.”

According to OPB’s Chris Lehman’s article: Johnson’s attorney, Beth Creighton, said the arbitrator’s ruling “establishes what we knew all along.”

Creighton: “This was not an isolated investigator going rogue, but a concerted effort by DOJ management to target Erious Johnson and cover it up.”

In addition to rehiring Williams, Blair ordered he be given nearly a year’s worth of back pay.

HARBR recommends the reader web-search the matter for more on the backstory. Suggested searches include:

Erious Johnson Oregon DOJ

James R. Williams Oregon DOJ

Williams claims that he had been following orders related to the allegations that he had profiled Erious Johnson. Williams also claims he was a victim of retaliation for whistle-blowing. Erious Johnson is the Director of Civil Rights with the DOJ, one of the few African-American members of Oregon’s DOJ, and the alleged victim of William’s profiling.

According to the OBP article, Rosenblum reports that both Johnson and Williams have further suits pending against the DOJ.

HARBR does not know whether contentions remain between Johnson and Williams. If contentions between these two persons remain, HARBR, at this point, does not have enough information to evaluate merits or to issue opinions.

Creighton: “For the record, Mr. Johnson was never asked if he wanted Williams terminated and in fact did not want to see him terminated.”


Photo Credit: Photo of Ellen Rosenblum provided by Wikimedia Commons

Page URL: https://commons.wikimedia.org/wiki/File%3AOregon_Attorney_General_Ellen_Rosenblum_addresses_attendees_at_the_conference_(15478927731).jpg, File URL: https://upload.wikimedia.org/wikipedia/commons/3/36/Oregon_Attorney_General_Ellen_Rosenblum_addresses_attendees_at_the_conference_%2815478927731%29.jpg, Attribution: By Oregon Department of Transportation (Ellen Rosenblum) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

HARBR Declares CPEP “Unaccredited”

HARBR Declares CPEP “Unaccredited”

May 25, 2017 Investigative Report by Christian Wolff

CPEP stands for “Center for Personalized Education for Physicians.” CPEP is a “Corrective Action” program which healthcare licensees are often forced to go to as a condition of “possibly” saving their licenses once their boards have asserted allegations against them. There is a CPEP in Denver, Colorado and one in Raleigh, N.C.

Today, HARBR pronounces CPEP to be unaccredited and unprofessional.  Let’s start out with the facts. CPEP has a webpage. They make no claims to being accredited. They have no posted email address. On March 27, 2017, I wrote them on their email contact form under the name of David Setson. I asked them whether they were accredited and if so, by whom. Five weeks later, I had received no response. On May 1, 2017 I wrote them again, letting them know what I would assume and publish if I did not hear from them regarding their accreditation. As of today (28 days later), I have received no response from them. Those are facts. For this and other reasons, I declare them to be unaccredited and unprofessional. The website for the Center for Personalized Education for Physicians (CPEP) can be found at http://www.cpepdoc.org/. If you care to contact them, you can do so using their contact form. If you would like to report your experience to HARBR, to can write and send your experience to info@harbr-usa.org.

Since snail mail, telephone, and CPEP’s own contact form is the only way to contact them, they have made it difficult for people to document their experiences. One method is to use their contact form, expand the “Message” box by pulling down on it’s lower right corner, and making sure your entire message is visible (all at one time). Then take a full page screen shot. Most computers have ways this can easily be done. If you do not know how, it may be worth learning because HARBR will be following up with similar investigations of similar programs, and you may wish to participate.

HARBR does wish to say that we are not out to malign all “corrective” programs. We do wish, however that programs such as CPEP would present honestly, well, and transparently. HARBR will continue to have objections to the methods many healthcare boards employ in their approaches to coerced assessments and treament, but we will be happy to publish or findings if and when we find programs like CPEP who are legitimate or open to reform.

For more on healthcare licensing boards use of coerced assessment & treatment and their connection to sham assessment and treatment facilities, visit this HARBR website regularly.

Next story in this series: Acumen Institute and Acumen Assessments located in Lawrence, Kansas.

If you would like to see the actual content of Christian “David Setson” Wolff’s communications with CPEP or if you would like a copy of this story which may be suitable for your attorney’s use, you may view or download this PDF:

HARBR CPEP DECLARATION May 25 2017

 

Oregon Senator alleges “Bureaucratic Malpractice”

Oregon Senator alleges “Bureaucratic Malpractice”

May 12, 2017 – In a statement released today, Oregon Senator Brian Boquist (R – Dallas) condemns the the Oregon Health Authority (OHA) for poor policies regarding mental health treatment for veterans in Oregon. He states, “The Oregon Health Authority is holding hostage our veterans and their families, and OHA’s is requesting ransom payment from providers. OHA’s Certificate of Need process is a form of bureaucratic malpractice.”

The Healthcare Alliance for Regulatory Board Reform (HARBR) applauds Sen. Boquist for his use of the term “bureaucratic malpractice” and for identifying it in Oregon government. HARBR intends to add the term “bureaucratic malpractice” to its glossary as it addresses the problems related to the regulation of professional healthcare practice in Oregon and elsewhere.

See the full press release at: https://www.oregonlegislature.gov/senaterepublicans/Documents/Boquist%20OHA.pdf

Photo: From Press Release