Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The breakdown of the rule of law in medicine

Vamsi Aribindi, MD
Physician
September 30, 2019
178 Shares
Share
Tweet
Share

The United States is a nation of laws, not of men’s dictates.  The rule of law is what keeps (most) drivers from routinely running red lights, police officers from demanding bribes, and our civil servants and elected officials largely honest.  There, of course, will be violators of this code, as there are in any society, but nonetheless compared to many other nations in the US most citizens and state officials believe the laws are legitimate, and by and large obey them.  One of the most bitter criticisms of President Trump and proximate cause for his impeachment proceedings is that he is breaking down a critical part of the rule of law.  By using tools of state commonly felt to be apolitical (foreign policy, the justice department) to go after his political opponents; issuing executive orders that seem to punish certain religious or ethnic groups, thereby legitimizing white supremacy; and attacking institutions respected by all such as the FBI, intelligence agencies, and the judicial branch, he is accused of slowly diminishes respect for those institutions and the sense that the institutions of the state serve all citizens fairly and equally.  This then threatens to breakdown the trust that all Americans have in our nation, which is critical to its continued existence.

This ongoing debate caused me to consider the rule of law in health care, and to realize that it has completely broken down as well. Have you ever seen someone in scrubs in the grocery store?  Technically that’s strictly prohibited by most hospitals’ regulations.  Eating food at the nursing station, drinking coffee while rounding on patients, wearing a cloth scrub cap in the ORs, grabbing a warm blanket for yourself from the patient warmer, grabbing a juice cup from the patients’ pantry food supply: all of it is technically banned, and yet almost all of those behaviors are commonplace in every hospital in the country.  Especially on the night shift — after all, few to no inspectors (from the Joint Commission which is the accreditation body with the power to punish hospitals for violations) or administrators work past 5 p.m. or before 9 a.m.

Most of these violations are harmless, no matter what the bureaucrats say.  But the lack of respect for such regulations and rules is not always confined to such relatively benign issues. Every day in most every hospital in America, a large percentage of health care workers do not wash their hands as they walk into patient’s rooms, despite many interventions to make it universal.   Another serious problem is low rates of use of medical translators.  Despite laws mandating that patients with limited English proficiency be provided independent and trained medical translators, doctors and other providers still commonly use their own partial language proficiency, draft family members (including children) as ad hoc translators, or worst of all just speak very slowly and loudly in English while gesticulating.  Needless to say, it doesn’t work, and critical details are sometimes lost with terrible results.  Many (particularly for-profit) hospitals don’t even provide translators.  There are multiple reasons for this: limited resources, emergencies, etc., but oftentimes there is no acceptable justification.

There are two sources for the breakdown of the rule of law in medicine.  One of them is immense time pressures and patient needs; when there are 15 patients left to see at 2 p.m., some already waiting 3 hours past their appointment time, doctors get a fairly powerful message from their administrators and powers that be to cut corners.  This is a very hard problem to fix.

But there is an easier target: the other, useless rules that no one respects.  Casually looking the other way or bemoaning to a fellow health care worker that you got caught by an administrator or the Joint Commission leads to tolerance of more serious violations that actually hurt patient care.  If every day, no one cares about a doctor scarfing down a sandwich while desperately finishing notes and putting in orders on a 20 patient list, they are less likely to care when someone runs into a patient room on the way to the OR and has a 10-year-old ask their mom about whether they have a headache or numbness and tingling after a neurosurgical procedure.

One answer then is to start reducing the rules that no one respects, and truly focus on enforcing the regulations that actually matter with appropriate exemptions for emergencies and other situations.  Some progress is being made, with the Association for periOperative Registered Nurses (AORN) recently retracting a rule banning cloth hair coverings after much criticism that it reduced morale, contributed to burnout, and did nothing to actually help patients.  But there is a long way to go.

Vamsi Aribindi is a surgery resident who blogs at the Medical Intellectual.

Image credit: Shutterstock.com

Prev

Do physicians really need such extensive training?

September 30, 2019 Kevin 6
…
Next

Medical schools need to produce more clinician-activists to help drive social change

September 30, 2019 Kevin 3
…

Tagged as: Surgery

Post navigation

< Previous Post
Do physicians really need such extensive training?
Next Post >
Medical schools need to produce more clinician-activists to help drive social change

More by Vamsi Aribindi, MD

  • The conflict between pharmacists and their corporate superiors

    Vamsi Aribindi, MD
  • The dangerous precedent of Alfie Evans

    Vamsi Aribindi, MD
  • Does the public shaming of Carmen Puliafito go too far?

    Vamsi Aribindi, MD

Related Posts

  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • Why academic medicine needs to value physician contributions to online platforms

    Ariela L. Marshall, MD
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD
  • KevinMD at the Richmond Academy of Medicine

    Kevin Pho, MD
  • This physician is burned out. But not for the reason you think.

    Anonymous
  • Practicing medicine without a license is illegal.  Yet cannabis dispensaries are doing it.

    Jill Becker, MD

More in Physician

  • What is driving physicians to the edge of despair?

    Edward T. Creagan, MD
  • Do residents deserve the title of physician?

    Anonymous
  • When an MBA degree meets medicine: an eye-opening experience

    Arthur Lazarus, MD, MBA
  • The hidden gems of health care: Unlocking the potential of narrative medicine

    Dr. Najat Fadlallah
  • The dark side of immortality: What if we could live forever?

    Ketan Desai, MD, PhD
  • It’s time for C-suite to contract directly with physicians for part-time work

    Aaron Morgenstein, MD & Corinne Sundar Rao, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Do residents deserve the title of physician?

      Anonymous | Physician
    • A new era of collaboration between AI and health care professionals

      Harvey Castro, MD, MBA | Tech
    • When an MBA degree meets medicine: an eye-opening experience

      Arthur Lazarus, MD, MBA | Physician
    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Health Inequity Should Be Labeled as a 'Never Event'
  • Healing the Damaged Nurse-Physician Dynamic
  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Do residents deserve the title of physician?

      Anonymous | Physician
    • A new era of collaboration between AI and health care professionals

      Harvey Castro, MD, MBA | Tech
    • When an MBA degree meets medicine: an eye-opening experience

      Arthur Lazarus, MD, MBA | Physician
    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The breakdown of the rule of law in medicine
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...