Recommended by Ricochet Members Created with Sketch. Doctor Pseudomonas

 

When other American soldiers were dodging bullets in Vietnam, I spent most of my time in military hospitals and research centers. This included stints in bacteriology where I got to observe the saga of Dr. Pseudomonas.

We called him Dr. Pseudomonas because of how often this species of bacteria (I think we determined it was P. aeruginosa) was found when the surgical incisions of his patients were swabbed and cultured post-op. There were several surgeons on staff at this small hospital, supported by the same surgical teams and in the same surgical suites. Their patients were placed in the same wards and rooms tended by the same staff. Different people collected swabs for culture. The only common factor in this unusual pattern of contamination was the surgeon.

He was not highly regarded by the nurses and corpsmen who cared for his patients. My barracks roommate at the time (a Vietnam combat medic and a very skilled stitcher in his own right based on my real-time observations of his ER work) said Dr. Pseudomonas’ suturing technique was reminiscent of that of the late Dr. Victor Frankenstein—large, too tight and certain to leave the largest scars possible.

One does not lightly accuse a lieutenant colonel M.D. of bad hygiene or poor technique. The documentation was assembled, a careful, discreet report made to the commander of the base medical unit, and everyone was ordered to remain silent about the matter. Naturally, all hell broke loose. Dr. Pseudomonas wanted the lone civilian employee in the BacT lab fired, the lab officer sanctioned and every enlisted man in the hospital questioned by MPs as to the origin of the nickname “Dr. Pseudomonas” (not sure who told him but the Army was then and ever shall be a gossip factory). Higher ranks and cooler heads prevailed but they did not remove this hack from doing surgery (but did accelerate his retirement, I was told).

After the Army, I went to Georgetown on the GI Bill, working nights in hospital labs. Some years later while I went to law school, because of this medical experience I was hired as a paralegal in a firm that did lots of high-end medical malpractice work. I have enormous respect (and sympathy) for the complexities, risks, and demands placed on physicians. I am also acutely aware that credentials are no guarantee of good performance.

It is not just that Dr. Pseudomonas was a hack. It was that he expected that his rank and position entitled him to deference and that absolutely no one beneath him in status had standing to question his work and that those of comparable standing should not come after a fellow member of the club. The kind of credentialism favored by Dr. Pseudomonas is pernicious and has widespread consequences.

In my various career experiences, I also learned that there are a lot of Ph.D.’s and MD’s out there who will give expert testimony for or against almost anything for a fee so hack lawyers (or politicians) can say to their opponents “my whore is a better liar than your whore—wanna settle?” [My employers never stooped to this nonsense to hire hacks like these and kept to extraordinarily high standards.] Later, when I did mostly lobbying work, I had to read many “studies” offered by activist groups, trade associations, and congressional committees that should have been regarded as literature, a highly specialized form of fiction. But the credentials of the authors of such work are invariably unassailable.

Not only does the US have a lot of bad policy ideas in effect because of nonsense from highly credentialed sources (e.g., our utterly unscientific COVID strategies, the militant exclusions of sane thus heretical climate science research, grossly incompetent foreign policy analysis, and social sciences not only divorced from reality but hostile to it thus adversely affecting education and child development) but bad policy ideas, like some sci-fi mutant parasite, are somehow now able to instantly grow defensive layers in academia, news media, politics and even social media “fact-checkers.”

These layers produce an annoying but now predominate social phenomenon we could call “credentialism by proxy” in which pointing out the failings of Dr. Pseudomonas is met with claims that the critic has no standing to question The Science because of the credentials of the accused. Logic, math, and data –and sometimes even comparable credentials–have no standing and no power to penetrate these defensive layers.

If a Dr. Pseudomonas injures a surgical patient, there are litigation remedies but if he offers a really bad idea relied upon by Congress or state governments that injures millions, there is no redress. I had thought that the conflict of credentialism, rank, and status versus evidence in the case of Dr. Pseudomonas was a unique, one-off event in my life. But now it seems like it’s happening all over and Dr. Pseudomonas’ side is winning often.

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  1. EODmom Coolidge

    Amen. 

    • #1
    • September 29, 2020, at 8:33 AM PDT
    • 2 likes
  2. Arahant Member

    Old Bathos: But now it seems like it’s happening all over and Dr. Pseudomonas’ side is winning often.

    Americans have always suspected credentials, with good reason. Whatever happened to, “But what have you done for me lately?”

    • #2
    • September 29, 2020, at 8:52 AM PDT
    • 6 likes
  3. Barry Jones Thatcher

    My Dad (who was a banker but also Chairman of the local Hospital Board for several terms) said 50% of all the Doctors in the US graduated in the bottom half of their class at Med school, so be wary of just credentials…seems like a good plan to me.

    • #3
    • September 29, 2020, at 9:09 AM PDT
    • 9 likes
  4. MarciN Member

    The professions are like every other group of people. There some who make you wonder how they ever got as far as they did, and then there are those who save your life. In my own life, my experience with doctors has been above and beyond excellent. They always seem to get right to the heart of the problem and fix it. As a group of people, I could not think any more highly of them.

    I’ve been dealing with some health issues over the last eight months, and I’ve met quite a few doctors. I admire them so much–their sense of humor, common sense, respectfulness, and intelligence. It’s not just book smart. It’s talent–and their drive to make people feel better than they do.

    That said, the doctors the OP is talking about are the ones who have left private practice–maybe for a good reason. :-)

    • #4
    • September 29, 2020, at 9:12 AM PDT
    • 3 likes
    • This comment has been edited.
  5. Old Bathos Moderator
    Old Bathos

    MarciN (View Comment):

    The professions are like every other group of people. There some who make you wonder how they ever got as far as they did, and then there are those who save your life. In my own life, my experience with doctors has been above and beyond excellent. They always seem to get right to the heart of the problem and fix it. As a group of people, I could not think any more highly of them.

    I’ve been dealing with some health issues over the last eight months, and I’ve met quite a few doctors. I admire them so much–their sense of humor, common sense, respectfulness, and intelligence. It’s not just book smart. It’s talent–and their drive to make people feel better than they do.

    That said, the doctors the OP is talking about are the ones who have left private practice–maybe for a good reason. :-)

    I have also known some doctors who have some transcendent qualities that seem to arise from intuition, a love of their work, and insight into human nature or something like that. They not only find the solutions but convey the right way to think about the experience of the problem that is in itself healing.

    • #5
    • September 29, 2020, at 9:52 AM PDT
    • 12 likes
  6. MarciN Member

    Old Bathos (View Comment):

    MarciN (View Comment):

    The professions are like every other group of people. There some who make you wonder how they ever got as far as they did, and then there are those who save your life. In my own life, my experience with doctors has been above and beyond excellent. They always seem to get right to the heart of the problem and fix it. As a group of people, I could not think any more highly of them.

    I’ve been dealing with some health issues over the last eight months, and I’ve met quite a few doctors. I admire them so much–their sense of humor, common sense, respectfulness, and intelligence. It’s not just book smart. It’s talent–and their drive to make people feel better than they do.

    That said, the doctors the OP is talking about are the ones who have left private practice–maybe for a good reason. :-)

    I have also known some doctors who have some transcendent qualities that seem to arise from intuition, a love of their work, and insight into human nature or something like that. They not only find the solutions but convey the right way to think about the experience of the problem that is in itself healing.

    Yes. 

    • #6
    • September 29, 2020, at 10:10 AM PDT
    • 1 like
  7. Susan Quinn Contributor

    I’m glad they probably got rid of that doctor early, but I’m so disappointed that the medical profession seems reluctant to point out the hacks. Their work can clearly result in life or death outcomes. 

    • #7
    • September 29, 2020, at 10:14 AM PDT
    • 4 likes
  8. Gossamer Cat Coolidge

    Susan Quinn (View Comment):

    I’m glad they probably got rid of that doctor early, but I’m so disappointed that the medical profession seems reluctant to point out the hacks. Their work can clearly result in life or death outcomes.

    I don’t believe that any profession can police its own. The urge to protect is too great.

    • #8
    • September 29, 2020, at 10:33 AM PDT
    • 8 likes
  9. Old Bathos Moderator
    Old Bathos

    Susan Quinn (View Comment):

    I’m glad they probably got rid of that doctor early, but I’m so disappointed that the medical profession seems reluctant to point out the hacks. Their work can clearly result in life or death outcomes.

    A tough old surgeon once fussed at me for ever being a lawyer. Lawyers go after doctors for things beyond their control, he said, but when there is an effort to remove an actual hack, the hack’s lawyers step in and block it.

    It is often not an easy call. A good physician just had a bad day, human frailty? How egregious or how frequent does the error have to be? Does the standard being applied make the rest of the specialty of the profession more vulnerable to attacks on a professional license or malpractice claims? And natural sympathy for one who may lose the full value of the enormous investment in medical education and training. What exactly and specifically was Dr. Psuedomonas doing wrong that caused this outcome? Could he have been sanctioned by a hearing on the basis of the swab evidence alone? Probably not. 

    • #9
    • September 29, 2020, at 10:38 AM PDT
    • 5 likes
  10. MarciN Member

    Old Bathos (View Comment):
    A tough old surgeon once fussed at me for ever being a lawyer. Lawyers go after doctors for things beyond their control, he said, but when there is an effort to remove an actual hack, the hack’s lawyers step in and block it.

    Interesting. A dear friend of mine, the superintendent of our school district, said roughly the same thing about teachers. Most of the teachers in our district were excellent, but when there was one who needed to find other work, the union’s lawyers would step in. It was very frustrating. 

    • #10
    • September 29, 2020, at 10:56 AM PDT
    • 4 likes
  11. Susan Quinn Contributor

    Old Bathos (View Comment):
    It is often not an easy call. A good physician just had a bad day, human frailty? How egregious or how frequent does the error have to be? Does the standard being applied make the rest of the specialty of the profession more vulnerable to attacks on a professional license or malpractice claims?

    I know that some malpractice suits are frivolous. But when the hack’s peers are aware of his repeated poor practice, they should report him. Yes, it might make others more vulnerable, but it will also tell doctors that they need to take their work seriously and responsibly.

    • #11
    • September 29, 2020, at 11:01 AM PDT
    • 2 likes
  12. Ontheleftcoast Member

    The past is another country. In the mid 1970s I was working in a satellite location of a major biomedical research lab. There was another lab on the same floor, I think it was one of ours too, but I’m not sure. One of the researchers in that lab was a physician who was fresh from a cardithoracic surgery residency in the UK, and was doing basic research en route to a PhD. One of her mentors in the residency did stuff that a top surgeon apparently could get away with in the UK back then, but which, to put it mildly, wouldn’t be allowed today.

    Get this: Her mentor kept the nail on one of his pinky fingers long. It was shaped and sharpened, too. He believed that it was the best available instrument to use for opening up stenotic heart valves.

    In case you’re thinking, “Wait, what? no gloves?” That’s right. This man’s scrub was lengthy and meticulous, and he had one of the lowest infection rates of any of the surgeons in his hospital. Or so she said.

    Not all that long after, AIDS was in the news.

    • #12
    • September 29, 2020, at 12:46 PM PDT
    • 11 likes
  13. Bob Thompson Member

    MarciN (View Comment):

    Old Bathos (View Comment):
    A tough old surgeon once fussed at me for ever being a lawyer. Lawyers go after doctors for things beyond their control, he said, but when there is an effort to remove an actual hack, the hack’s lawyers step in and block it.

    Interesting. A dear friend of mine, the superintendent of our school district, said roughly the same thing about teachers. Most of the teachers in our district were excellent, but when there was one who needed to find other work, the union’s lawyers would step in. It was very frustrating.

    Isn’t this what I have heard is a problem with the big city police departments shedding their poor or ‘bad’ performers? An open process that actually works could enhance their credibility.

    • #13
    • September 29, 2020, at 12:47 PM PDT
    • 4 likes
  14. Sisyphus Coolidge
    SisyphusJoined in the first year of Ricochet Ricochet Charter Member

    Bob Thompson (View Comment):
    Isn’t this what I have heard is a problem with the big city police departments shedding their poor or ‘bad’ performers? An open process that actually works could enhance their credibility.

    Imagine the devastation and tumult if corporate journalism tried it.

    • #14
    • September 29, 2020, at 12:51 PM PDT
    • 7 likes
  15. Skyler Coolidge

    I really like your post and I appreciate your larger point, but I’m tickled by your mention of P. aeruginosa. Back in my younger days I studied biology through the National Science Foundation at Purdue. My area of study was “Acquired Immunity in Manduca Sexta.”

    Manduca sexta is the tobacco hornworm, so I guess I was a shill for the tobacco companies somehow. Nevertheless, I enjoyed injecting 5th instar caterpillars with P. aeruginosa and E. coli and seeing how the hornworms survived compared to whether they had already recovered from a non-lethal dose. Bleeding caterpillars was just a side benefit, I guess.

    All I knew about P. aeruginosa is that is was pretty dangerous and I’d better be careful because if any got in my eye, then my eye would dissolve. I still have my eyes, so I guess I was okay. I’d never heard anyone talk about P. aeruginosa ever since that time.

    Many years later, I had a military dentist who was a full commander. I’m embarrassed to say that I needed to get fillings. This dentist yelled at the dental tech the whole time he was working on me, the poor tech was scared of him. And then he did a terrible job on my teeth. I went back to get it corrected and he scolded me quite rudely saying it was all good and stop wasting his time. On my way out, a young woman dentist, pretty cute, stopped me and snuck me into her chair and fixed the problems. She told me that was one of her most common jobs, fixing the idiot commander’s mistakes. I was very thankful for her care. Those fillings are still in place after 34 years thanks to her.

     

    • #15
    • September 29, 2020, at 1:16 PM PDT
    • 10 likes
  16. Skyler Coolidge

    Gossamer Cat (View Comment):

    I don’t believe that any profession can police its own. The urge to protect is too great.

    I agree. When my battalion was in Afghanistan, we had a lieutenant who had already been put in hack for drinking and driving, having affairs when he married, and other sins. In Afghanistan he left the wire with an interpreter to go to a wedding and get laid. No court martial because the battalion commander thought it would embarrass him and his dream of running for office on return.

    Of course, it’s incredibly stupid and dangerous to leave the wire in a vicious war zone like that. The man is insane. But not having any bad paper, he was free to resume his job as a police officer where he bragged that he liked the job because he gets to beat people up.

     

    • #16
    • September 29, 2020, at 1:21 PM PDT
    • 7 likes
  17. Bob Thompson Member

    Skyler (View Comment):

    he was free to resume his job as a police officer where he bragged that he liked the job because he gets to beat people up.

     

    This is the kind of thing that could be a real systemic problem and it might even be mistaken for racism.

    • #17
    • September 29, 2020, at 1:26 PM PDT
    • 5 likes
  18. Skyler Coolidge

    Bob Thompson (View Comment):

    Skyler (View Comment):

    he was free to resume his job as a police officer where he bragged that he liked the job because he gets to beat people up.

     

    This is the kind of thing that could be a real systemic problem and it might even be mistaken for racism.

    Or old fashioned thuggery, kind of like the two friends in “Clockwork Orange.”

    • #18
    • September 29, 2020, at 1:31 PM PDT
    • 3 likes
  19. MiMac Thatcher

    Susan Quinn (View Comment):

    Old Bathos (View Comment):
    It is often not an easy call. A good physician just had a bad day, human frailty? How egregious or how frequent does the error have to be? Does the standard being applied make the rest of the specialty of the profession more vulnerable to attacks on a professional license or malpractice claims?

    I know that some malpractice suits are frivolous. But when the hack’s peers are aware of his repeated poor practice, they should report him. Yes, it might make others more vulnerable, but it will also tell doctors that they need to take their work seriously and responsibly.

    If you go after a fellow MD you better have very good documentation, otherwise you typically get hit with the threat of a law suit claiming restraint of trade- and that isn’t covered by your malpractice. 

    • #19
    • September 29, 2020, at 2:05 PM PDT
    • 5 likes
  20. kedavis Member

    Barry Jones (View Comment):

    My Dad (who was a banker but also Chairman of the local Hospital Board for several terms) said 50% of all the Doctors in the US graduated in the bottom half of their class at Med school, so be wary of just credentials…seems like a good plan to me.

    Early in the 12-year-I-think run of the series ER, there was the riddle posed:

    What do you call the guy (or gal, now) who graduates last in their class from medical school?

    Doctor.

    • #20
    • September 29, 2020, at 2:47 PM PDT
    • 6 likes
  21. MiMac Thatcher

    kedavis (View Comment):

    Barry Jones (View Comment):

    My Dad (who was a banker but also Chairman of the local Hospital Board for several terms) said 50% of all the Doctors in the US graduated in the bottom half of their class at Med school, so be wary of just credentials…seems like a good plan to me.

    Early in the 12-year-I-think run of the series ER, there was the riddle posed:

    What do you call the guy (or gal, now) who graduates last in their class from medical school?

    Doctor.

    Q:What do you call the dumbest guy in law school?

    A: Your honor.

    • #21
    • September 29, 2020, at 4:48 PM PDT
    • 8 likes
  22. kedavis Member

    MiMac (View Comment):

    kedavis (View Comment):

    Barry Jones (View Comment):

    My Dad (who was a banker but also Chairman of the local Hospital Board for several terms) said 50% of all the Doctors in the US graduated in the bottom half of their class at Med school, so be wary of just credentials…seems like a good plan to me.

    Early in the 12-year-I-think run of the series ER, there was the riddle posed:

    What do you call the guy (or gal, now) who graduates last in their class from medical school?

    Doctor.

    Q:What do you call the dumbest guy in law school?

    A: Your honor.

    Or maybe Congressman, or Senator…

    But hopefully not Mr President, unless Biden wins.

    • #22
    • September 29, 2020, at 5:20 PM PDT
    • 2 likes
    • This comment has been edited.
  23. The Reticulator Member

    Gossamer Cat (View Comment):

    Susan Quinn (View Comment):

    I’m glad they probably got rid of that doctor early, but I’m so disappointed that the medical profession seems reluctant to point out the hacks. Their work can clearly result in life or death outcomes.

    I don’t believe that any profession can police its own. The urge to protect is too great.

    A good reason to get the ABA out of the business of vetting judicial appointments.

    • #23
    • September 29, 2020, at 6:29 PM PDT
    • 4 likes
  24. Gossamer Cat Coolidge

    The Reticulator (View Comment):

    Gossamer Cat (View Comment):

    Susan Quinn (View Comment):

    I’m glad they probably got rid of that doctor early, but I’m so disappointed that the medical profession seems reluctant to point out the hacks. Their work can clearly result in life or death outcomes.

    I don’t believe that any profession can police its own. The urge to protect is too great.

    A good reason to get the ABA out of the business of vetting judicial appointments.

    Yup

    • #24
    • September 29, 2020, at 9:19 PM PDT
    • Like
  25. Roderic Reagan

    Interesting post. Now do lawyers.

    • #25
    • September 30, 2020, at 11:04 AM PDT
    • 2 likes
  26. kedavis Member

    Roderic (View Comment):

    Interesting post. Now do lawyers.

    It’s probably a lot more difficult to trace the infections spread by lawyers.

    • #26
    • September 30, 2020, at 11:42 AM PDT
    • 5 likes
  27. Old Bathos Moderator
    Old Bathos

    Roderic (View Comment):

    Interesting post. Now do lawyers.

    In the context of credentialism, a law degree prepares one to make use of other people’s expertise and in crafting whatever use legislature or judges may make of it. In theory, the adversary system mitigates a lot of potential harm for that usage. An entirely different critique would be required.

    • #27
    • September 30, 2020, at 12:00 PM PDT
    • 2 likes
  28. CarolJoy, Thread Hijacker Coolidge

    Old Bathos, over the last ten years, at least here in California, so many huge changes have occurred inside the health care field that you would most likely not recognize health care any more.

    Emergency room care is extremely screwed up. The ER doctors spend a huge amount of time stalling around, to figure out if you are pain med seeking. Although this is good for weeding out those people who are that, for people who are in an actual emergency situation and made to wait out an extra hour or two, it can be an excruciating situation.

    This was a perforated appendicitis problem. But doctors did not seem to relate to Mark saying he had a pain in his right side, to any consideration of the idea he might be in the throes of appendicitis. Since he had on his chart from prior doctor visits some hernia problems, they kept dismissing his current situation.

    Finally they decided to allow him to be give an CT scan for the appendix. That CT scan came back negative. I was tremendously suspicious of the scan being negative, especially when I found out the person reading the scan was “down in Southern Calif.” I figured the scan reader was probably over in India. I demanded a second look at the scan, and then he was finally diagnosed as having a perforated appendix. If I had not been around this particular day, and off visiting friends in the MidWest, he would have been sent home to die.

    We had gotten to the ER at 2:30 Pm; he was finally sent to occupy a hospital room at 7:30 Pm.

    End of Pt One

    • #28
    • October 1, 2020, at 1:16 AM PDT
    • 3 likes
  29. CarolJoy, Thread Hijacker Coolidge

    Part two

    Hospitals have the patients under their care & only their care – no longer does one’s personal physician come in to check up on the patient. Instead a team of hospital doctors are in charge of the patient. In my spouse’s 5 days in a local hospital, which was part of the Sutter franchise, he had a total of 4 doctors that checked in on him in the five days he was there.

    One of these doctors was exceptional. He had a good beside manner as well as tremendous knowledge of both of my husband’s health problems. He was the only one of the four doctors who treated my questions as decent normal ones, and did not make everything into an argument. Because of him, I was able to get a prescription for a medicine both of us had been trying to obtain for 2 years. (Not a pain med, but rather a medicine that Big Pharma no longer has any interest in, so very difficult to get.)

    Everything is now digitized – and with one’s personal GP no longer able to come and see you when you’ re in the hospital, it worries me that doctors would take the computerized info about you as infallible, which is worrisome. In my last 20 years, I have had to straighten out two situations when tests occurred that my insurance paid for that had nothing to do with me. Someone either used my insurance info to get testing done, or the computer glitched. But if doctors do not know you, what happens when they depend only on the digitized information?

    HIPPA has also taken a toll on the situation. At one point, I realized I left the nursing station phone number on Mark’s bedside table. So I called from home to ask the hospital receptionist to give me the number. She refused, saying that if he wanted me to call him, he’d call me. She referred to HIPPA as prohibiting her from handling the situation differently. (He was on morphine and wouldn’t know how to figure out where the phone was or how to place the call.)

    When I talked to friends about the hospital experience Mark endured, several mentioned that ER doctors no longer can diagnose a patient – that everything relating to diagnosis must be done by lab testing. Only the testing; no human interface. However, people have bodies that respond to testing much like our cars do: our organs might work perfectly during a test & then go back to malfunctioning just as our cars do when we take them to the mechanic. Plus scans and X rays re indeed being read by third world people, not locals.

    To me it seems less & less likely that the all important human interface between doctor and patient is encouraged. And some are stating that this COVID “crisis” is the pretext by which even more of the patient to doctor experience will end up being patient to AI device.

    • #29
    • October 1, 2020, at 1:26 AM PDT
    • 2 likes
    • This comment has been edited.
  30. Old Bathos Moderator
    Old Bathos

    CarolJoy, Thread Hijacker (View Comment):

    To me it seems less & less likely that the all important human interface between doctor and patient is encouraged. And some are stating that this COVID “crisis” is the pretext by which even more of the patient to doctor experience will end up being patient to AI device.

    A lot of this is driven by the insurance/health care conglomerate companies. Time-consuming personal touches, lab tests ordered on an informed hunch, etc are increasing being crushed out by demands for uniform robotic procedures which are (a) cost-driven; (b) just enough to establish a standard of care records in case of malpractice claims, and (c) great if they actually solve the patient’s issue. In that order.

    Free market-based medicine was supposed to select for both quality and efficiency but we are increasingly getting neither. People opposed single-payer health care mostly because it would take away their favorite doctor and his wise, personal Marcus Welby MD style and his trusted guidance when a specialist was required. But if we are going to be jerked around by impersonal bureaucratic processes and mediocre service, why pay a premium for that?

    • #30
    • October 1, 2020, at 6:29 AM PDT
    • 2 likes