You may compromise patient safety

A recent comentary in JAMA Open Network highlights recent research indicating that empathy and respect for patients, in communications between clinicians, may enable better information recall and thereby avoid negative impacts on patient safety and quality of care. 

Empathy and respect for patients may seem like an obvious value under the old "bedside manner" rubric, but that's not what this is about. The research now shows that when one clinician tells another clinician something negative or stigmatizing about a particular patient, that communication hurts the patient's safety and the quality of care. When it's a cultural habit (as it often is) among medical staff, medicine itself is less effective.

It seems that almost every "patient" I ever knew in Illinois' forensic psychiatric system, i.e., on the plantations in Elgin, Chester, Chicago, Springfield, Anna, Alton... is stigmatized, disrespected, and described negatively by staff. Patients are all presumed to be defective, mentally disordered. Nobody can tell exactly what is wrong (supposedly, with their brains), so it's just a general constitutional inferiority, a fault or a subhumanity: these patients really can't be respected or empathized with, their vaguely defined  "illnesses" make them a nuisance and unpredictable, always hard to understand, often dangerous. 

In fact, psychiatric "diagnoses" are nothing more than epithets. They never help or enable any improvement. They are negative, stigmatizing tales about people, meant only to justify brute control. That doesn't necessarily imply condemnation of psychiatry, or of any particular psychiatrist's specific practices, as harmful to patients. My biggest objection has always been to the total dishonesty, the fraud. This is not any medical specialty which applies scientific knowledge to help people with their problems in thinking, feeling and behaving. It is an unnecessary, cowardly excuse for justice. It merely wastes human talent, blood and treasure. 

Read a few months' worth of progress notes for any individual. They will be over-obviously about almost nothing but how the person screws up, functions poorly, is mentally sick. But there is no real disease, there's only the fact that the clinicians writing these things don't like psychiatric patients, don't understand them, have no empathy, and don't know what to do with them.

The best example I can cite, perhaps, is Gus, who has been told repeatedly over some years, that nobody likes him. His psychiatrist, Dr. Vikramjit Gill, told Gus in so many words that he is the most disliked patient at EMHC. There's no way Dr. Gill would have said that directly to Gus (and I've heard him do so, myself, in monthly staffings when I was present), if he hadn't said it many times to other staff first.

Gus has been stigmatized, so he gets picked on, attacked and neglected. This is exactly what the JAMA commentary is about. Stigmatizing patients creates a degraded and unsafe standard of care in any medical institution. Gus has repeatedly suffered from medical conditions that probably would have been avoided or quickly remedied anywhere other than EMHC.

But psychiatric institutions are not so medical, at least not in the sense of real hospitals. They are a special case. They only stigmatize patients.

That's their business.