More Name and Shame Trolls
An Item on 3 News about Psychwatch, a Name and Shame website complaining about lapses in the mental health system. The Mental Health services are understandably, and quite justifiably, annoyed.
“Mental Health Commission chairman Peter McGeorge said today that focusing attention on individuals who work within mental health teams was unfair and was unlikely to bring about improvements in services.”
This is far too mild a way of putting it. As far as I am concerned, these people are complete troglodytes and their blog should be treated with the contempt it richly deserves. Let me explain the reasons for my ire.
Firstly, let me say that Psychwatch restrains itself to Naming people it has some evidence against. This is a slight mitigating factor, as it manages to avoid some of the egregious abusiveness of venom sites. But remember that this is evidence from sources that have not considered it justifiable publishing these names, yet the author of the site thinks he knows better. Note that the author, Steve Taylor is a councillor, not a trained psychologist or psychiatrist.
Worse, the evidence he uses is from the Health and Disability Commission (HDC) website. HDC findings are made around the patient bill of rights and are often fairly unrelated to actual clinical practice. For instance, I myself have been found “in breach” of patient rights – because I did not write complete enough notes on a patient! This is hardly Name and Shame territory, but my case is up on the HDC website (and no, I am not going to link to it!). The point being, of course, that a breach of rights is not necessarily a breach of competent care.
One of the cases Mr Taylor has placed on his site appears to have been through the HDC process, and the parents of the patient involved appear to have placed all their grievances on the site, despite the HDC not finding serious fault. I consider this to be a grudge post.
The other, far more serious, names a health worker after a full internal investigation exonerated her. The correct thing here would be to take it to the HDC, not bang it up on a website.
Mr. Taylor sounds terribly noble about his site:
“Psychwatch New Zealand is seen as a supplementary service to consumers and families who are currently fighting to either secure reasonable access to mental health services, or those consumers and families who may be fighting for justice against what can seem at times as a system almost impregnable to meaningful accountability.”
Balderdash, Mr. Taylor. You have taken away the rights of health workers to a fair hearing. HDC at least only names health workers in the severest of circumstances, as a last resort. You seem to think it is your right to bung up names on whatever you think is enough evidence. You are destroying their lives and their careers because you have judged them. Not their peers, not the HDC, not the medical council or relevant body. Just you.
Judge, jury and executioner.
Hope you never make a mistake Mr. Taylor, because your peers are likely to be as merciful to you as you are to them…
Additional:
Psychwatch has now been threatened with legal action. I am quite surprised- that it took so long.
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- Dark Brightness » Blog Archive » Naming and Shaming: the consequences — [...] good macdoctor has discussed the Psychwatch site. Quoting my [...]
Sep 16 08 3:39 pm
Urrgh horrible business and I would like to add that this sort of silliness is a reason for otherwise qualified people to stay clear of the mental health field.
Sep 16 08 8:25 pm
Local patient advocate showed me a printout of the site today.
Some issues.
1. All doctors make some mistakes every year, and we all pray that no one gets hurt. But they happen. We have systems (peer review, audit, double checking of important information) to minimise them.
2. In psychiatry we are often trying to make a decision where there is little data to guide us… and where the research is changing rapidly.
3. Most doctors who have had complaints against them take them seriously. Complaints generally make docs less confident, more scared or defensive (which is generally a bad thing) and much more mistrustful of patients (which is a very bad thing).
4. A number of patients make repeated complaints to authorities. Psychiatry and GP collect these kind of patients.
5. There is a duty on all doctors to protect the public, which can include asking colleagues, ones employer, and at times the medical council for backup in getting that doctor back to competence.
6. If one still believes that these sites are worthwhile, I suggest you look at NHS Blog doctor and the hell many GPs there have gone through due to anonymous complaints from patients.
The Health and Disability Commissioner has done, in my view, managed to hold the balance between identifying issues that need correction and avoiding “naming and shaming”.
A return to that state would lead, again, to all health professionals being silent about poor practice out of fear of the inquisitors: which is what Mr Taylor will get if this type of site remains, whether he wants it or not.
Sep 16 08 10:26 pm
Chris: Good comment. You are quite correct – psychiatry has the unenviable position of being the easiest discipline in which to make mistakes and the one that attracts people most likely to complain. I am always amazed that anybody still wants to work there!
Sep 17 08 10:18 pm
Goodness me, where do I start?
The ad homenim attacks about me not being a psychiatrist or clinical psychologist, but simply a mere counsellor? (I challenge anyone from either the psychiatric or clinical psychology field to provide evidence that match my outcomes with clients – my clients don’t just feel better – they get better, and they stay better – go the the “client feedback” section of my Practice website http://www.24-7.org.nz for further information; the puzzling irrelevance posted above regarding where I source my information? – each case has an evidential paper trail, 1st person report, and more often than not corroborating witnesses to the events posted; or shall we just leap into a discussion about say…. oh I know, let’s start with the pathology of depression – oh, yes, there isn’t any, is there? The whole “chemical imbalance” theory is just that, isn’t it? A theory? Dr William Glasser (a Psychiatrist) had it right after all. Next please – oh, and keep an ear out for Morning Report on Radio NZ tomorrow – there have been some rather rapid developments in favour of my client.
Psychwatch NZ – where results are virtually guaranteed.
Steve Taylor,
Convenor,
Psychwatch NZ
Sep 18 08 1:52 am
Steve: Where to start indeed.
It is not an ad hominem argument to point out that you do not have the qualifications or knowledge base to accurately judge a psychiatrist or psychiatric nurse. It is simply the truth. The matter of your competence as a councillor is completely irrelevant to the argument. I am a very competent ED doctor, but I am utterly unqualified to judge one of my psychiatric colleagues. You are even less qualified to do this than I.
You may consider my calling you a troglodyte to be an ad hominem attack and I accept that. However, as Webster’s dictionary defines a troglodyte as “a person characterized by outmoded or reactionary attitudes”, I think the description fits you to a “T”
The fact that you can’t see why the source of your information is important, is only additional proof that your Name and Shame site is merely a vindictive one-sided rant. You clearly do not appear to be able to distinguish between a complaint and actual written evidence, so your “evidential paper trail” is worthless.
I have no idea why you drag poor William Glasser into the argument unless it is to demonstrate your colossal arrogance in thinking you know better than everyone else in the mental health universe.
You, Mr. Taylor, are dangerously smug. I reiterate my warning to you.
Hope you never make a mistake Mr. Taylor, because your peers are likely to be as merciful to you as you are to them…
Sep 18 08 8:37 am
Macdoctor:
You demonstrate a rather tiring yet quite familiar arrogance of the medical field – you believe that a medical degree and the authority to prescribe somehow make you more “right” than anyone else. I mop after you pricks all of the time – your profession is often allergic to correction, blind in your professional hubris, and have a seeming inability to understand any client intervention outside the scientific realm. I understand ethics, as my reference point is codes of ethics, and thus I can quite easily discern between ethical vs unethical behaviour; I can discern between competent and incompetent care, as my reference source is best practice protocols, protocols your own industy creates; if you truly believe that you are unqualified to determine either of these professional markers in your colleagues, then that either makes you an apologist for incompetence or a coward.
You choose.
I notice you have nothing to say about the pathology of depression? Glasser = 1; Medical Fraternity = 0.
Steve Taylor
Sep 18 08 9:12 am
Oh now I get it. Psychwatch is about drumming up more support for a counseling service by creating a climate of mistrust and fear amongst the general public. I find that far more abhorrent than any of the crimes you talk of.
Sep 18 08 9:12 am
Steve:
Your hatred of the medical profession is obvious. You make statements about my professionalism and my beliefs which are blatantly untrue, based only upon the fact that I oppose your mud-raking site. You merely confirm my observations about the vindictive nature of your site.
I am stunned you have the audacity to claim ethical behavior when your actions are anything but. You apparently cannot discern the difference between revenge and restitution. If you think it ethical to slap someone’s name on your grubby little site based only on your own judgement, then you have no notion of ethics at all.
Your reliance on protocols to determine acceptable management of a patient is precisely why you have no right to judge medical behavior. You have absolutely no ability to judge whether an action outside the protocol is justifiable or not.
I do not condone incompetence or negligent behavior, but there are proper channels for dealing with these things. Your website is NOT one of them.
PS. Calling me an apologist or coward is an ad hominem argument. It is also a straw man fallacy as there is a third alternative – I am right.
PPS. I have nothing to say about Glasser because it is not relevant to our discussion. However, just so you know, I find his theories intriguing and have never discounted their value in mental health practice.
Sep 18 08 4:48 pm
Macdoctor:
1/ I don’t hate the medical profession. I happen to believe that medicine and counselling can be complimentary to each other. What I detest is tertiary elitism – within any profession.
2/ You are entitled to your opinion – I am entitled to disagree with you.
3/ I would welcome some evidence from you that I have been unethical in my advocacy for my client (you know what a client is, aye, the people we are supposed to serve?)
4/ If protocols set up by an industry that are used as benchmarks to determine acceptable practice and client management are not to be used as reference points for acceptable practice and client management – what would you suggest should be used? Clearly, “like” judging “like” is a spectacular failure – doesn’t work for mental health workers, police, or politicians,so why in the world would it work in medicine?
5/ How do you account for the fact that my “grubby little website” has resulted in a positive outcome for my client within 48 hours of the orginal post about the Waitemata DHB worker being uploaded? Coincidence, or the result of shedding some light into the darkness?
Sep 18 08 4:53 pm
Steph:
I’m booked a month in advance, and rely 100% on word of mouth referral for my Practice.
It’s not like I need to “drum up business” – if you read the client feedback on my website at http://www.24-7.org.nz you will quickly see why this is the case.
Steve Taylor
Sep 18 08 5:39 pm
Psychwatch:
I think you are confusing professionalism with elitism. I am not saying you are too stupid to judge a doctor or nurse, I am saying that it is unlikely that you have a full appreciation of all the factors involved in a situation. This is due to asymmetric knowledge, rather than intelligence.
I am sure you are a good advocate for your client. The fact that you obtained a good outcome for your client by posting the information on your site is not relevant. The ends never justify the means. I note that legal pressure has been brought to bear on you in this matter – and so it should have.
The problem is simply that you have no accountability to anyone but yourself. You do not seem to be able to recognize the dangerous consequences of your actions. That you request me to prove that your behavior is not ethical only serves to emphasize my point.
Peer-reviewed tribunals are a much better way of dealing with mistakes and wayward behavior amongst professionals. It has worked well in medicine. The essential ingredient, missing from police and political peer systems is transparency. By transparency, I do not mean blazoning a name across the web, but having open procedures and systems, preferably with lay participation, and preferably with back up.
You could have taken the Waitemata health worker to HDC. If they had been a doctor, you could have even taken them to the medical council. Instead, you chose to publicly humiliate them.
Perhaps you would like to bring back the stocks – and lynch mobs?
Sep 18 08 8:00 pm
Macdoctor:
I am a member of three professional associations who can censure, sanction, or expel me from membership, and I have an external clinical supervisor I meet with on a monthly basis – I think I have the accountability issue covered. The fact that I have made a stand on this issue in full view of my entire industry is a salient fact that is not lost on me regards accountability.
The HDC investigate 1 complaint in 10, and then minimise true transparency in the cases they do investigate by NOT naming the individuals concerned. If the WDHB worker had not been named, there would have been no way that my client would have been so rapidly and positively attended to by the WDHB.
It wasn’t until the worker was named that the WDHB decided to act appropriately – up until then, the WDHB had been quite obstructive.
If you watch this you will see how initially obstructive the WDHB was in the duty of care to my client:
http://www.tvnz.co.nz/view/video_popup_windows_skin/1884428
My point is that naming the worker wasn’t the first resort – it was the last resort.
Consider this: if the client had been one of your family, and the client was subjected to what my client was…..how hard would you have expected me to advocate for one of your own?
Something to think about?
Sep 19 08 12:40 am
Psychwatch:
You misunderstand. I am not talking about accountability vis a vis your profession, but with respect to your publishing information on your website. You have no accountability for this, as you can publish whatever you wish, whether true or not.
It appears that you may be having a good outcome from this. This is fortunate, as the result could have been unpleasant. I wonder how you would have felt if the health worker whose name you broadcast had committed suicide due to the pressure? This is not an implausible scenario. I accept that you thought you had no other alternative. I just think you were wrong – you had plenty of others, including the HDC.
The HDC 1 in 10 story is a red herring. 90% of the complaints sent to HDC are trivial and do not require investigation. They are sent to mediation to resolve them. And I reiterate once again that transparency and naming are not the same things. Naming private medical businesses and people is substantially punitive. HDCs attitude to naming is quite reserved for this reason. In general, for doctors and nurses, they prefer the disciplinary body to deal with this.
And if one of my family where your client I would indeed expect you to advocate for them, as I would advocate for my patients. But I still would not have approved of you using your website in this manner.
Sep 19 08 9:41 pm
Macdoctor:
I guess the best way I can sum up my response to your last post is to say that I am a big believer in the law of natural consequences. My response is my responsibility; their (whoever they are) response is their responsibility.
I don’t believe that the end justifies the means; I simply believe that doing the right thing is more important than doing the easy (or ultimately ineffective) thing.
In this case, I believe I made the right call for the client, and given a similar situation, I would do the same again.
I just hope that I don’t have to – but then again, I probably will have to.