Let’s paraphrase an old joke: a woman walks into the doctor’s office for an examination. “You’re too fat.” the doctor says. “I want a second opinion,” says the woman. “You’re ugly, too,” says the doc.
An interesting firestorm is brewing in New Hampshire over the comments of Dr. Terry Bennett, a Harvard trained physician who prides himself in “telling it like it is.” When the story first broke, it appeared that the woman patient had brought a complaint against the doctor for simply saying she was fat. An immediate groundswell of support emerged for the doctor, whose candor, the pundits felt, was in the best interests of the patient. Anti-attorney websites railed at yet another frivolous lawsuit defaming a sincere and well-meaning physician.
As is so often the case in these situations, the first take on the story was somewhat over-simplified. According to a recent article, the NH Board of Medicine is looking into a complaint related not to the comment about being fat, but the racial slur that accompanied it. Here’s the quote from the good doctor as presented by the board: “You need to lose weight. Let’s face it. If your husband were to die tomorrow, who would want you? Well, men might want you, but not the types that you want to want you. Might even be a black guy.”
If that indeed is what Bennett said, you could certainly argue that his comments go well beyond the normal bounds of medical protocol. (The good doc would probably enjoy a recent movie release entitled “The Aristocrats” — an homage to bad taste in which the same basic — and obscene — joke is told by dozens of comics, but that’s a different story.)
Bennett is no stranger to this type of controversy. In another case going back to 2001, a patient accused him of suggesting she commit suicide. The documents paraphrased what Bennett, 67, allegedly told the patient, who was suffering from the effects of brain surgery. “(Bennett) spoke to the patient in an unprofessional manner suggesting that she purchase a pistol with which to commit suicide as a means of putting an end to her life.”
Bennett denies doing anything wrong. “They’re trying to make me the poster boy for bad medicine,” he said. “I’m making them the poster boys and girls for insane law enforcement … for interference of my First Amendment rights.” Bennett has his supporters, including many of his patients, among whom is a black man who calls Bennett a personal friend.
So what’s the issue here? And is there anything wrong with the candor of Dr. Bennett?
I am all for candor in communication. There are undoubtedly some obese people who need to be confronted with the life-threatening risks inherent in their situations. Such confrontation, when done in a caring and supportive manner, can be an effective way of getting someone’s attention, especially if they are in denial. But if the quotes are accurate, Dr. Bennett needs a course in communication skills. He has not just violated the standards of good taste. By inappropriately bringing up his patient’s sex life — and by demeaning her further through disparaging references to blacks — he has crossed a boundary that exists not just in the doctor – patient relationship, but in employer – employee relationships as well. His comments reveal a hostility and an edge that is totally inappropriate. Many of us enjoy a good joke, but Bennett’s comments appear to be less an attempt at humor than at gratuitous humiliation. That’s just bad medicine. And regardless of what the first amendment pundits say, the Board is doing the right thing by investigating the situation.
Archive for August, 2005
Let’s paraphrase an old joke: a woman walks into the doctor’s office for an examination. “You’re too fat.” the doctor says. “I want a second opinion,” says the woman. “You’re ugly, too,” says the doc.
Our thoughts and prayers go out to the people of southern Louisiana, Mississippi, and Alabama. In watching CNN last night, I was struck by the bravery of the police, firefighters, and volunteers who put themselves in harm’s way to rescue survivors. Health care workers are also doing an amazing job under terrible circumstances: staffing flooded hospitals, tending to refugees in the Superdome, and relocating elderly nursing home residents.
The disaster recovery is boggling in scope, and we will no doubt address it further. For now, here are some health and safety resources for rescue workers:
Worker safety after a flood
Worker Safety in a Power Outage
Emergency Response Resources for Workers
Response, Cleanup and Safety for Workers
The above links were found via Poynter. The Poynter Institute is a school for journalists, future journalists, and teachers of journalists. The website is often a good source of information for large, breaking news stories. In addition to the above links, they also have an extensive list of links to post-disaster health and safety resources for civilians and workers alike. It seems like a good time to give these resources wider circulation.
Online news coverage
In addition to the national media outlets, here are some online resources to local coverage.
NOLA – Breaking News from the Times Picayune
The Irish Trojan – a New Orleans area blogger who is posting frequent updates
Today’s Times Picayune – special online edition in pdf
Large graphic of the New Orleans levee system
Some of the following links to online TV resources can be slow loading due to demand.
WLOX – streaming video from Biloxi, MS
WJTV – online video from Jackson, MS
WPMI – online video from Mobile. AL
WLTV – online streaming video (embedded) from New Orleans
Joe Paduda has a post on Katrina’s impact on insurance costs in which he links to several articles and offers good commentary.
While on vacation in Acadia, Maine, my family participated in a lobster boat tour, culminating in a visit to the tiny village of Frenchboro on Long Island. As I listened to the informative and entertaining talk by the boat’s captain and watched him retrieve a full trap from the ocean floor, I knew there had to be a blog in the compelling story of the lobster.
The life of a lobster is not as dull as you might think. To be sure, as a fledgling lobster, your relationship with your mom would have to be described as pretty remote: you are ferried about as an egg on her tail for the first year or so; you have anywhere from 5,000 to 100,000 siblings. But life is good in the cold waters of the Atlantic. Many of your major predators have been fished to the point of near extinction. Every year, when you get tired of the same old outfit, you shed your shell and grow a new one. It’s worth noting that the opportunities for reproduction occur only during the molting period. A hard shell is indeed a formidable barrier to any reproductive behavior. In the summer you hang out along the coast; in the winter, you migrate out to the deep waters, where you forage the warmer bottom waters along with your fellow crustaceans.
Your only problem as a lobster is that your meat is prized in the restaurants and markets of North America and Europe. In Maine alone, the lobster catch has reached 70 million pounds in one year, up from the prior level of 20 million pounds. In an attempt to prevent over-fishing, regulators are trying to strike a balance between the lobsters taken out of the water and those left behind to breed. In Maine, lobster fisherman are required to throw back any lobsters too small and large females with eggs (they carry a tool that quickly shows them whether the lobster is too small or too big for keeping). And because the large females prefer large males (I’ll pass on that one), the latter are also tossed back into the deep cold waters (a pretty good deal for the big guys).
One of the most intriguing aspects of lobstering is the matter of licenses: who is able to set traps and who is not. In the small island communities near Acadia, the issue is hereditary. You have to be born in Frenchboro, a small community of 50 hardy souls nestled in the bay of a remote island, or you have to marry someone who was born there. If you move there when you are two months old, it just doesn’t count. They have a one room school house up to grade eight for the 15 kids, who then attend a regional high school on the mainland by ferry plus bus (weather permitting). (They also have high-speed internet, so I wonder how many kids will want to stay around to take on their birthright careers.) Only these privileged few are allowed to secure a license to set traps in the designated waters off the coast of the island. If you come from somewhere else and happen to set your traps over the line, someone will cut the ropes, for sure.
Up the coast, Cutler used to be one of the less regulated areas for obtaining a lobstering license in Maine. Then times changed and a man from Connecticut moved in, became harbor master, and brought a little organizational discipline to the field. Some of the locals resented the outsider. Read the fascinating story here.
When I first heard of the lobster wars — the fierce territoriality of the fisherman, the cutting of lines and abandoning of traps — I wondered what happened to the poor lobsters and crabs caught in the traps. Were they doomed to die in the the narrow confines of the traps? As it happens, there is a way out. Each trap is fitted with a “ghost door” — an escape hatch that is held in place by hardware that disintegrates after a month or two. If for any reason a trap is not retrieved in the usual week or so, the ghost door will eventually open and the lobsters will be able to escape. Of course, while waiting for the door to open, the bigger lobsters will eat the smaller ones, and the crabs as well. The door opens, and one big lobster crawls out. So much for family ties…
Lobster fishing is an extraction industry, as are mining and lumber. The valued natural resources are extracted and sold, usually until the stocks are exhausted. We have seen the results of over-fishing in the great waters of the north Atlantic: the stocks are depleted and the fishing industry is dying. Lobstering is a precarious and hazardous pursuit, but it appears that steps have been taken to ensure that lobsters will continue to thrive in their chosen habitat. I could barely keep my feet in Maine’s frigid waters for a minute, but to a lobster, it’s a comfortable home, the perfect place to scuttle among the rocks, periodically upgrade the wardrobe, and check out the molting action. Not my idea of fun, but it appears to work for them.
Earlier this week, the Trust for American’s Health issued a new report on obesity in Anmerica with the disturbing news that about 25% of American adults are obese. Health Daily News Central has more information on the details of this report. We’ve also previously blogged about obesity and workers comp.
About the same time this report was released, the news broke that Dr. Tony Bennett is being investigated by New Hampshire’s Attorney General and the New Hampshire Board of Medicine for offending one of his patients by telling her she was obese and needed to lose weight. He refuses to apologize for his remarks and faces possible disciplinary action ranging from a reprimand to revocation of his license.
We don’t know exactly what the doctor said or the manner in which he said it, but we have to wonder if this woman isn’t taking the state’s motto of “live free or die” a little too much to heart. Should a doctor only tell patients the health information that they want to hear? We don’t think so, and would be interested in hearing your thoughts on the matter.
Reactions from the blogosphere
Obesity is a well defined condition. It responds to weight loss. How can this possibly have caused a stir? — DB’s Medical Rants
He was “reported” for telling a patient the truth. If we cannot tell patients that they are obese – and that they should do something about it – then can we tell patients to stop smoking, or stop drinking – or what about crack cocaine? — DB’s Medical Rants
When did rudeness become a matter for attorneys general? — Medpundit
The NH Medical Board either a) has information about this that’s way more serious than that alreayd announced, or b) is filled with utter morons without enough do.
Time will tell. — GruntDoc
… But if the reporting is accurate, it would seem to be another piece of evidence that contradicts the frequent excuse of tort-reform opponents that aggressive medical malpractice lawsuits are needed to compensate for under-vigilant medical boards. — Overlawyered.
Kevin, M.D. has posted more reactions from the blogosphere
We talked a bit about “framing” on Monday – the depersonalization that can occur when people are lumped into broad categories or stereotypes, and how that pigeonholing can set the trajectory for future behaviors and events. Thus, an injured worker can make the leap from being your best employee to a rather suspicious “claimant” in one fell swoop. So it was of some interest when, in doing our weekly medical blog rounds, we came upon a post that related to the transformation and depersonalization that often occurs when one becomes “a patient.”
Rita Schwab at MSSPNexus points us to a story in The New York Times about the degrading shift from person to patient* that often occurs when one crosses the threshold into a hospital. Rita comments that, often, ” … the courtesies that help lubricate and dignify civil society are neglected precisely when they are needed most, when people are feeling acutely cut off from others and betrayed by their own bodies.”
She excerpts this incident from the article:
“Mary Duffy was lying in bed half-asleep on the morning after her breast cancer surgery in February when a group of white-coated strangers filed into her hospital room.
Without a word, one of them – a man – leaned over Ms. Duffy, pulled back her blanket, and stripped her nightgown from her shoulders.
Weak from the surgery, Ms. Duffy, 55, still managed to exclaim, “Well, good morning,” a quiver of sarcasm in her voice.
But the doctor ignored her. He talked about carcinomas and circled her bed like a presenter at a lawnmower trade show, while his audience, a half-dozen medical students in their 20’s, stared at Ms. Duffy’s naked body with detached curiosity, she said. “
If you or a family member has been hospitalized recently, you may identify with some of the stories and issues discussed in the article. It made me recall The Doctor, an old film in which William Hurt played a successful but brusque surgeon who learned what it feels like to have the tables turned after he gets cancer.
(* If the NYT article is archived, you may be able to access it from here with free registration.)
What happens when your injured workers visit the doctor?
Employers need to give some thought to what happens when their injured workers become patients. As Rita points out, this is a very vulnerable point for your employee and the medical milieu can be a highly confusing and frustrating labyrinth. In addition to all the regular depersonalization inherent in encounters with the medical world, employees who seek care under the banner of workers comp can be made to feel like they are somehow less worthy, second-class patients. And in a sense, they are – workers comp rates are generally discounted by fee schedules and network negotiations; further, some providers are reluctant to be involved in what they see as a potentially contentious case.
Employers that truly care about the recovery of their injured workers would do well to assume the role of patient advocate. This entails advance planning by seeking out and meeting the quality medical providers near your facilities and making these doctors familiar with your organization and your return-to-work programs. In representing your work force, you have more buying power and more influence to ensure timely service and priority care than any one individual walking in off the street would. If an employee is experiencing frustration or confusion during the course of treatment, you want to know that and be in a position to help resolve those issues whenever possible. If you don’t pay attention to those frustrations, an attorney would be glad to!
Often, employers think that managing the relationship with providers is the job of the insurer or the contracted network, but we would argue that this is not a relationship that can be “outsourced” on the day-to-day managerial level. Employers need to be an active participant in this relationship, and to ensure that injured employees get top quality care and service. And we would add that a good place to begin is to be more concerned with quality than with discounts when seeking out a network or a doctor — in fact, we often encourage employers to pay more to ensure good service. Cheap medical care is no bargain; a few extra dollars spent early might be the best bargain of all.
Malcom Gladwell, author of a book called Blink, was recently on a news show discussing the tragic death of Jean Charles de Menezes, the innocent Brazilian who was erroneously killed by British police in their zeal to prevent another London subway bombing. Among the many interesting observations Gladwell made was one that particularly resonated with me. He noted that once police have framed someone as a criminal, all subsequent decisions are made in this context. Innocent behaviors may appear ominous when viewed through the prism of criminality.
In this terrible case, we first heard that the deceased was exhibiting suspicious behaviors – wearing a bulky, seasonably inappropriate coat, running from police, jumping turnstiles, etc. In retrospect, we learned that most of these reports were simply not true. Menezes was on his way to work like every other day, but on this day he had the misfortune to be framed as a terrorist suspect. When a group of police identified and pointed him out as he sat on a subway car, he apparently stood to face them. In the context of an imminent terrorist threat, a simple action became a death sentence.
I haven’t yet read Gladwell’s book, but his commentary sent me to Amazon reviews. The book is about decision making based on “rapid cognition” – first impressions, snap judgments, framing, and the like – it looks like an interesting addition to a late summer reading list.
“Problem” as the default assumption
We frequently see this type of “rapid cognition” and framing when someone is injured at work. For many employers, workers comp is a hot button issue. It is expensive, confusing, and fraught with potentially sticky employment issues. It may involve litigation. Suspicion runs high. It is an issue that is generally framed as problematic right from the outset. Because the overall context is problematic, every dealing with the employee is viewed through a problem prism. This negative framing can be a self-fulfilling prophecy. A *good* employee is mystified as to why he or she is suddenly treated with suspicion.
When I first came to workers comp, I was quite ignorant of the issue beyond the fact that it was serious enough to be driving some employers here in Massachusetts out of business. The word “fraud” was bandied about readily. Lynch Ryan founder, Tom Lynch, did not think fraud was the nub of the problem. While he allowed that fraud existed, he saw problems as emanating more from the fact that employers were treating what is essentially a human issue as simply a financial equation. He wondered why two very similar injuries could evoke such vastly different responses depending on whether they occurred on or off the job. As an insurance industry outsider viewing the issue as purely a business problem to be solved, he did not bring the baggage of negative framing. Essentially, he approached things much the way my Mom approached the job of raising her seven kids: treat people fairly and consistently, reinforce good behaviors, expect the best, and treat problems as exceptions, not the rule.
Can something as simple as reframing the issue so that the default position in approaching an injured worker is not from the problem perspective yield better results? We obviously feel strongly that it can, and we think that the hundreds of clients we
Should employers be able to prohibit guns at the workplace? ConocoPhillips thinks so and is challenging a recently enacted Oklahoma law to assert that right. In response, the NRA will be launching a national billboard advertising campaign calling for a boycott of ConocoPhillip’s gas. The Christian Science Monitor recently discussed this issue in an excellent article entitled Worker right or workplace danger?
Many employers have policies prohibiting weapons in the workplace as part of their violence-prevention measures. Such policies often encompass the employer’s total premises, including the parking lot. But at least a few states have laws that override such policies and affirm an employee’s right to keep legal arms in their vehicles. Such laws are in force in Kentucky, Minnesota, and Oklahoma – and perhaps some other states.
Oklahoma’s law is fairly recent, enacted in response to the firing of a dozen Weyerhaeuser employees in 2002 for having guns locked in their cars in the company parking lot. The OK law offers some protection for employers from liability should one of these guns be used in the commission of a crime, but it’s not clear how the law could protect employers from workers compensation claims, such as those that resulted from worker injuries and deaths at Lockheed Martin. Workers comp does not usually come into play in cases of random violence – say a crazed killer walks in off the street and begins shooting employees – but it generally covers incidents that are found to be work-related, such as a disgruntled employee shooting co-workers.
Many employers think that policies against weapons make for a safer workplace. According to The Christian Science Monitor article:
“Although workplace homicides have declined dramatically in the past decade, weapons bans do appear to make workers safer, according to a recent study. Among hundreds of North Carolina companies surveyed, those that permitted guns to be brought to work saw a risk of homicide five times greater than companies that banned guns at work. “We saw a statistically significant increase in the chances of having a killing in any workplace that permitted guns,” says Dana Loomis, professor of epidemiology at the University of North Carolina at Chapel Hill.”
Do employers have the right to establish policies on their private property? The NRA frames this as a Second Amendment issues, though others would see it as an issue of property rights. Jacob Sullum takes on the issue of The NRA vs. the Constitution in Reason Online:
If the NRA were simply objecting to ConocoPhillips’ policy of barring guns from its parking lots, I would have no problem with the boycott. Instead, the NRA is objecting to the company’s defense of its right to determine the gun policy on its own property. “We’re going to make ConocoPhillips the example of what happens when a corporation takes away your Second Amendment rights,” declares NRA Executive Vice President Wayne LaPierre.
That statement makes no sense, since the Second Amendment is a restraint on government. The Second Amendment does not mean a private employer has to welcome guns in its parking lot, any more than the First Amendment means I have a right to give speeches in your living room.
LaPierre insists that “you can’t say you support Second Amendment freedoms, then turn around and support anti-Second Amendment companies.” I think you can, if you support property rights and understand what the Second Amendment really means.
With the recent passage of the Florida concealed weapons law, the defeat of the ban on certain assault weapons, and the protections from lawsuits recently enacted for the gun industry, it appears we are in an era where gun rights are expanding rather than retracting. How this will affect employers and their anti-violence policies remains to be seen. We’d love to hear your thoughts on these matters – we are particularly interested in the employer viewpoint.
OSHA inspections. Meg Fletcher of Business Insurance reports that OSHA is targeting about 4,000 high-hazard worksites for inspections in the coming year. Inspections will first target sites that “reported 12 or more injuries or illnesses resulting in days away from work, restricted work activity or job transfer for every 100 full-time workers in 2003. Nursing homes and random sites will also be inspected.
Ask the Donald a question about your business. We are pleased to welcome latecomer Donald Trump to the blogisphere. Donald, we are always happy to help out any noobie bloggers, so let us know if you have any questions. Meanwhile, if any of our readers have any questions they would like to ask the Trumpmeister, his site also features “Trump University” where you can pose questions to Mr. Trump or to his circle of experts.
HR acronyms. Does industry jargon leave you flummoxed? We have several workers comp and managed care glossaries listed among the tools in our sidebar. Thanks to B. Janell Grenier of Benefitsblog, we will also add a new tool � the Benefits Acronym Lexicon.
More costs for Ohio BWC. The Toledo Blade reports that the costs to investigate the widening Ohio Bureau of Workers Comp scandals are estimated at more than $6.5 million as the state hires forensic accountants, lawyers, financial consultants, and appraisers. The investigations focus on a series of losses ensuing from questionable investments, including up to $13 million lost in an investment in a rare coin fund and $215 million lost in a failed Bermuda hedge fund. According to the Blade, the scope of the investigation is complex: “There are already two convictions, three grand juries, 144 bureau investment managers under review, 420,561 pages of coin-fund records, and as much as $13 million missing from the coin funds managed by Tom Noe, the prominent Republican contributor at the center of the scandal.”
Falls are one of the leading causes of injury and death, both on and off the job. As one might guess, construction workers are particularly at risk – falls are the most prevalent source of fatalities in that industry, dwarfing other sources.
An Analysis of Fatal Events in the Construction Industry 2003 is a study that William Schriver of the Construction Industry Research and Policy Center, University of Tennessee, Knoxville, conducted for OSHA and the Centers for Disease Control. In the study, Schriver lists the leading causes of death:
OSHA inspected 707 fatal construction incidents (excluding non-work related causes), involving 730 fatalities, in calendar year 2003. Five of the 30 proximal causes classified in this report accounted for 296 (41.9 percent) of the fatal events investigated. They were: (1) Falls from/through Roofs: 76 events (10.7 percent); (2) Falls from/with Structures: 74 events (10.5 percent); (3) Crushed/Runover of Non-Operator of Construction Equipment: 56 events (7.9 percent); (4) Electrocution by Equipment Contacting Energized Wire: 47 events (6.6 percent); and (5) Electrocution from Equipment Installation/Tool Use: 43 events (6.1 percent).
Human Fall Traps
J. Nigel Ellis has spent his career studying falls and why they occur. In Fall Protection: Traps that Workers Can’t Avoid, a recent article in ENR.com, he discusses the phenomena of what he calls “human fall traps” or HFTs. These are situations in which falls are almost inevitable. Examples include hole covers that present the illusion of a solid walking surface, vertical handgrips, and open pits.
“There is no defense against HFTs because we can’t perceive them until it is too late. This is because we are human; a good analogy might be to say “you needed eyes in the back of your head” to see that rock coming. It is worse than that with HFTs. The cautionary phrases “Watch Your Step” or “Be Careful,” often used in toolbox meetings or training programs, don’t help. Training can’t protect against hazards that can’t be seen before it’s too late.”
In this excellent article, Ellis describes 14 specific HFT scenarios. He appeals to architects, engineers, and building contractors to be aware of and eliminate these hazards at the work site. Graphic examples of some of the hazards Ellis discusses are illustrated in a 2004 NIOSH alert that presents five case studies of worker fatalities from falls through skylights and roof and floor openings. This report also offers some recommendations for prevention.
Thanks to rawblogXport for the pointer to the Ellis story. We find a lot of interesting items at this fine weblog that outlines its mission as “union news, workers rights, construction, safety, and irony” – a tip of the hat to the authors.