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. The Reticulator Member
    The Reticulator
    @TheReticulator

    Old Bathos (View Comment):

    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?

    This is why I said that the art of medicine has now become paint by numbers. And if one of the numbers is smudged and the wrong color gets painted in that space, who is to say otherwise? (Not that all of medicine is an art. There is science, too. Politically approved science.)

    • #31
  2. Skyler Coolidge
    Skyler
    @Skyler

    Old Bathos (View Comment):
    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?

    But we don’t have free market medicine.  We have medicine controlled by the insurance lobby,  The free market hasn’t been involved in a very long time, and that is our problem.

    • #32
  3. Arahant Member
    Arahant
    @Arahant

    Old Bathos (View Comment):
    Free market-based medicine was supposed to select for both quality and efficiency but we are increasingly getting neither.

    This isn’t free market, though. It is mostly based on “insurance” companies paid for by employers as an employee “benefit.” Instead of doctor/patient price negotiations, we have healthcare conglomerate/”insurance” company negotiations, which removes everything from those who are closest to the action. Most people going in for healthcare have no idea what it really costs.

    • #33
  4. Headedwest Coolidge
    Headedwest
    @Headedwest

    MarciN (View Comment):

    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.

    The NYC teacher union is famous for preventing firing for even egregious misbehavior. Teachers who are so bad they cannot be allowed in classrooms report to locations where they sit all day, doing whatever, and collecting their full salary.

    They call them ‘rubber rooms’. 

     

    • #34
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