De ‘hulpverlenende’ sociopaat /
psychopaat
Onderstaand treft u informatie aan over
hulpverleners die aan een zeer ernstige persoonlijkheidsstoornis lijden: psychopaten c.q. sociopaten
(Lees b.v. het recentelijk in het Tijdschrift
voor Psychiatrie verschenen artikel ‘De diagnostiek van psychopathie geen probleem?’ van B.C.M. Raes). De hulpverlening
is voor hen een perfecte dekmantel doordat men niet gauw op het idee komt dat
psychopaten binnen de hulpverlening werkzaam zouden kunnen zijn. Helaas… een
misvatting. Juist binnen de hulpverlening is de sociopaat veilig want daar waar men hem/haar niet
verwacht, wordt hij/zij ook niet gauw ontdekt. De weinige collegae die hen
herkennen, doen er meestal niets aan, uit angst… . Zo blijven sociopaten deel uitmaken van de hulpverlenende sector
waarbinnen zij geen hulp verlenen maar juist hele grote schade berokkenen. En
dan wel niet alleen maar aan cliënten maar ook aan collegae, de
beroepsvereniging en de medische stand in het algemeen.
Een citaat dat iedere hulpverlener tot nadenken zou moeten aanzetten:
"What
hurts the victim most is not the cruelty of the oppressor, but the silence of
the bystander."
(Elie Wiesel, een overlevende van
de holocaust).
‘A
Prescription for the Rogue Doctor’
Part I – Begin With Diagnosis
Clin Orthop Relat
Res. 2003 Jun;(411):340-5.
De samenvatting van
het artikel luidt als volgt:
“Among the most serious problems a doctor can
have may be those which are the result of a defect of character (…). Examples of
unacceptable patterns of behavior include dishonesty,
intentionally harming a patient, sexual harassment, and substance abuse.
For years, the problem doctor who has these patterns has been handled with kid
gloves by those who educate, train, and supervise professionals in the
healthcare industry. Counseling,
coaching, training, supervising, transfers to less critical disciplines,
disciplinary warnings, and offering opportunities to resign have been the
typical protocols. Traditionally,
outright firing of residents and doctors has been relatively taboo and too
radical for the medical profession. Why
has this been the case? Reasons may include unwillingness to get involved or to deal with the stress of
disciplining a colleague, an unwillingness which often is grounded in fears that the problem doctor may retaliate. In a
litigious society, fears of slander lawsuits, for example, may be all-too-real. However, the implied paternalism and the
practice of protecting doctors’ careers by preserving their professional status
as practicing doctors have become increasingly problematic. Aside from the fact that it is unethical,
allowing problem doctors to continue to practice medicine may have an adverse
impact on the well-being of patients and therefore may represent an enormous
legal liability for organizations that employ them.”
Crow et al. introduceren hun
artikel met de navolgende woorden:
“Breaches of ethics
by medical doctors are well-documented.(…). Being belligerent, overbearing, and lacking
civility; being deceptive with colleagues and organizations; engaging in sexual
misconduct; practicing medicine despite incompetence or a lack of credentials;
evading malpractice data banks and not reporting mistakes and errors; and
murdering patients. (…). Specifically, sociopathic
doctors typically will have a facility for getting along in life and in their
profession throughout by cheating, deceiving, and taking advantage of people.”
Stephen M. Crow,
Sandra J. Hartman, Thomas E. Nolan & Michele Zembo,
2003
Deel II van het
artikel van Crow et al. draagt
de toepasselijke titel ‘Ready, Aim, Fire!’
Zoals eerder aangekondigd publiceren wij een gedeelte van bovenstaand
artikel. Het gaat om twee hoofdstukken uit deel I ‘A Prescription for the Rogue Doctor: Begin With Diagnosis’, namelijk:
·
Is It Denial?
·
Rogues
and Residencies
Het stuk zal een
vraag beantwoorden die zich helaas haast niemand stelt: hoe is het mogelijk dat men zelfs collegae de hand boven het hoofd
houdt die sociopaten zijn en soms zelfs degenen die
moorden plegen? De vraag is helaas niet ‘gebeurt dat dan wel?’ maar ‘waarom
gebeurt het?’. Onderstaande hoofdstukken afkomstig uit het artikel van Stephen
M. Crow et al. (2003) geven antwoorden op de vraag
hoe het mogelijk is dat zelfs sociopaten door
collegae beschermd worden. De antwoorden laten tevens zien hoe dergelijks zoals
hieronder beschreven te voorkomen zou kunnen zijn.
|
Is It Denial? “Michael Swango may be an extreme aberration or a good example of
the rogue doctor. On July 19, 2000 the
doctor entered a plea of not guilty to federal grand jury charges that he
murdered, attempted to murder, and assaulted various patients entrusted to
his care as a doctor at hospitals in the United States and abroad.33 Commenting on the impending trial, Stewart
stated that: This is not a
case of mercy killings, but of a doctor charged with using his professional
knowledge to become a serial killer.
The most shocking part of the story is that he was able to continue
practicing even after he was convicted of the nonfatal poisoning by arsenic
of coworkers in 1985. After being
investigated for murder at the Ohio State University Hospitals, he still was
able to find jobs as a hospital doctor in South Dakota, New York, Zimbabwe,
Zambia, and Saudi Arabia.33 At Ohio
State, doctors recommended that the doctor be licensed to practice medicine
even after he was accused of injecting a patient with a paralyzing drug and
after the death rate soared among his patients.33 Doctors chose to believe Dr. Swango over the eyewitness accounts of patients and
nurses, and returned him to patient duties after a cursory investigation
exonerated him. In South Dakota,
medical school doctors admitted Dr. Swango to the
university’s residency program and allowed him to care for patients even
after he admitted he had been convicted of poisoning coworkers.33 They believed the doctor when he
told them the conviction was a miscarriage of justice and never contacted
officials in Illinois, where the facts of the case were a matter of public
record. In New York, the doctor was
admitted to a residency program on Long Island by a committee of three psychiatrists
who believed his false claim that his felony conviction stemmed from a bar
room brawl.33 Again, no one
checked his story. Three of the murders alleged in the indictment occurred
during his subsequent tenure at a Who is
policing this behavior? Who is in denial? How could a rogue doctor such as this have
pulled off such crimes? In part,
doctors, even when exhibiting sociopathic behavior, are protected.
There are prominent people who are more than willing to put their own
careers at risk to help prominent people – as doctors often are – who are in
trouble.10,16 A United States Congressman and a former
state governor lobbied hospital officials on behalf of a surgeon who was
denied staff privileges because of his suspended medical license and a guilty
plea he made in a criminal case. The
hospital’s governing board had rejected the doctor’s request to practice,
saying he failed to disclose his license suspension and did not produce
transcripts of his guilty plea to mail fraud conspiracy charges stemming from
his work at a clinic that defrauded insurance companies. The doctor pled guilty in 1998 to
conspiracy to commit mail fraud and served 4 months in prison. The doctor also pled guilty in 1983 to
unauthorized use of a credit card, for which he received a suspended
sentence. He proclaimed his innocence
in both situations. The doctor may be
innocent. The key issue, however, is
that it is unlikely that these prominent men would have put themselves in the
media line of fire and jeopardized their credibility and careers by helping
someone in a less respected position. What is suggested is that public scrutiny
and governmental regulation cannot be counted on to police rogue
doctors. Ultimately, the medical
profession must police itself.
However, as the case reported by Stewart33 suggests, too
often rogue doctors are instead protected by a code of silence among those
who educate, train, and supervise them in the healthcare industry.9,36 One author stated that the ability of rogue
doctors to go unchecked is a failure of the medical profession to police its
own.35 Another author stated that the increasingly competitive
nature of healthcare and a lack of effective government control of medicare and medicaid
disbursements may have created a culture in the healthcare industry of fraud
and deception.4” Rogues and Residencies “The foundation of this paper was
presented by two of the authors - Crow and Hartman - to the Academic Orthopaedic
Society at their summer symposium in 1998.
The group was concerned that, just at the time when orthopaedic surgery is facing the need to have doctors
with high levels of professionalism, with good interpersonal skills, and with
the ability to work collaboratively in teams, there was considerable evidence
that many individuals in residency programs were deficient in these
skills. In general, the young
physicians who were the object of concern by the Society’s members are those
ranging in age from their early twenties to approximately 40 – members of the
Generation X.29 Research on
this group suggests that, relative to the groups immediately before them (the
Boomer Generation, now aged in their 40’s to nearly 60, and the Silents from 20 years before the Boomers), the Generation
X members are less accepting of others, less willing to accept authority and
hierarchy, and skeptical of society and its conventions.7,15,37 This is
not an easy group for healthcare leaders, typically from earlier generations,
to accept and nurture, but clearly only a small subset of these individuals
have serious character flaws of the sort being considered. The difficulty is in identifying who the
rogues are in this generation. Some of
the anti-authority behavior which characterizes many individuals from this generation, may become a lack of orthodoxy which turns
into creative ways of helping patients and moving medicine forward. But others in this generation may be a
special subset of rogues. Certain
rogues are low in social or emotional intelligence. Such people are unable to pick up social
cues about expected behavior.11
In contrast, the high self-monitor is extremely perceptive, picks up
cues, and adjusts behavior to suit – for as long as that behavior is being
observed. Such individuals may be the
stars of a residency program and their problems may not be observable until
they are past the Boards and in practice.
For such individuals, unfortunately, residency may not provide a
viable option for identifying potential rogues. But those of lower social intelligence who
do not have the capability to disguise their motivations and actions and
rogue tendencies above and beyond those of Generation X, may well surface
during residency. Allowing people like
this to continue in residency programs was seen by the Academic Orthopaedic Society as a threat not only to the
credibility of the programs but also to the profession. However, at best the get them out during
residency approach probably will identify only the low self-monitoring rogue.” Stephen M. Crow,
Sandra J. Hartman, Thomas E. Nolan & Michele Zembo,
2003 |
Hoe herkent u de ‘rogue doctor’ c.q. de sociopaat
in een collega als hij/zij met een klachtenprocedure wordt geconfronteerd?
(1) Het grensoverschrijdend gedrag (GOG) dat hij/zij pleegt, is
ernstig en vooral divers van aard.
(2) Het grensoverschrijdend gedrag beperkt zich niet tot alleen maar
GOG naar de cliënt toe maar de ‘rogue doctor’ maakt
eveneens misbruik van de groep waartoe hij/zij zelf deel van uitmaakt:
collegae, beroepsverenigingen etc..
(3) De reactie op een
klacht, hoe terecht dan ook, is extreem vijandig. Het verweer houdt geen
verweer in maar een verdere aanval.
(4) ‘Rogue professionals’ dreigen al snel met
klachten/maatregelen en/of dienen zonder enig probleem klachten in tegen
ex-cliënten (b.v. wegens ‘smaad’), collegae (indien zij niet door hen worden
gedekt) en zelfs tegen inspecteurs van de Inspectie voor de Gezondheidszorg of
tegen andere instanties.