The murder of Dr. Mark Hausknecht has been on my mind for the past several weeks. For those of you who haven’t followed the story, it appears that Dr. Hausknecht was killed by a man whose mother was a former patient Dr. Hausknect’s and she died during a procedure. The suspect, who is now deceased from suicide, apparently had a list of other physicians and medical staff that he may have been planning on targeting. To be clear, although this happened on a street that I frequent, I didn’t know Dr. Hausknecht personally, nor do I know the details surrounding the death of the suspect’s mother. What I do know is that it’s not the first time that healthcare providers and/or facilities have been targeted. In 1982, an armed man stormed St. Jude Children’s Research Hospital and took 4 personnel hostage. The suspect in that case was angered over the death of his child.
Dealing with the death of a loved one is never easy and grief comes in many forms. I hear myself say this phrase more often than I would like, “There’s no ‘right’ way to grieve”. The research on grief psychology often reports normal emotional response to death as feelings of ‘sadness, anger, disbelief, despair, guilt and loneliness.’ What isn’t listed is revenge.
There's no 'right' way to grieve Share on XWhat exactly is revenge? Revenge can be defined as:
- The desire to get even,
- Retaliation for injury, loss or humiliation
- Seeking symmetrical injury, harm, or loss
The ‘denial of death’ is a phrase coined by Ernest Becker, a cultural anthropologist, in his Pulitzer Prize winning book of the same title. The book focuses on how humans have developed strategies to fend off awareness of our own mortality and to escape into the feeling that we’re immortal. In our current society, the tremendous advances in medicine and technology have fueled this fire into a raging inferno and allow people to ignore the inherent limits that constrain the human body and its physiology.
It can become frightening to practice medicine in a culture where death is so feared that it leads to revenge. Revenge is directed passionately at a specific target with the intent of doing harm, because it is believed that the target has intentionally harmed the person seeking the revenge. When physicians and the care they deliver “fail” to fend off death, it does not constitute intentional harm. So why are doctors being threatened and targeted?
The well documented and growing distrust of the health care system and health care providers has pitted patients against physicians. The doctor-patient relationship is built upon a cornerstone of trust, yet the public’s trust of doctors has been slowly eroding since the 1960s. There are many theories to why this is happening and there is actually peer-reviewed research on the subject, yet I found these bullet points from a Physician’s Weekly Blog written by a family practice physician, Dr. Girgis, to ring true to my experience:
♦ Third parties [insurance companies] are often making decisions. For example, they dictate [what medicine they will pay for], and we often have our hands tied as to what medications we can prescribe. I often have patients ask me for the “strong Stuff.” They don’t realize that doctors are limited in prescribing habits, and we are not withholding the best medications. But, we are the ones in direct contact with the patient.
♦ Outlier doctors have been gaming the system. Most doctors truly put patients’ care first, before profit. But, there are a few who inappropriately use their medical degrees for profit. Just look at Dr. Oz trying to get rich promoting weight loss products with no proven benefit. These doctors make us all look bad. [This is particularly salient in cancer care when unfounded ‘cures’ are promoted. This is the lowest of the low to prey on sick and dying patients.]
♦ There are many mandates imposed on us that affect patient care. One example is meaningful use. Doctors now have to document many metrics, inputting data into our [electronic health record] systems, in order to meet requirements. Patients take this lack of eye-to-eye contact as a sign that we are more interested in their digital record than them. They feel we are no longer listening to them. They don’t realize that we don’t want to be doing this. It has been opposed on us from on high, and we will be penalized if we don’t.
♦ HMO’s have greatly cut reimbursements to doctors. In order for practices to stay afloat financially, we have to see more patients. We need to find more and more room to see these extra patients if we want to stay afloat. Patients feel this and take it as an indication that we are pushing them through for profit and don’t care about them. [This is not something I experience in my own practice because you can’t “create” more pediatric cancer patients, but patients do bring these previous experiences with them to my clinic.]
♦ Media tends to portray doctors in a bad light. There are big stories about the pill mill doctors and those arrested for fraud or harassment. There are so many more amazing stories of heroic doctors around than the bad apples. But the press does not give them attention. People rather see the bad than the good. This too tends to paint us all in a negative light.
We live in a world where death is unwelcomed and feared. It is often medicalized. It is seen as a failure.
In denying death, are we denying life?
Can we begin to rebuild the broken relationship between physicians and patients so that we may understand each other better? Through relationship building, can we help patients and their families deal with loss in ways that are not filled with anger and revenge? Can we help our patients see death not as a failure of anything or anyone, but as the end result of a life lived?
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**Please note that I am not implying that any doctor who is threatened or hurt is at fault because of poor patient-physician relationships. I have seen some of the kindest and most honest physicians threatened despite providing phenomenal patient care (and this goes back to the issue with death denial).
These tragic events were used to merely bring to light several fractures in our system that I have observed.
