The world has a long history of suppressing inconvenient truths, inconvenient opinions, inconvenient people, and those described as heretics. Unfortunately, the tendency to persecute and even kill those we disagree with us remains alive and well today. We may not be actually burning people alive at the stake today, but social media has made it very easy to destroy anyone with name-calling and mislabeling the actions and opinions of others. In the case of physicians, medical boards have had no trouble taking away the licenses of physicians who questioned the propaganda put out by Fauci and the Centers for Disease Control and Prevention (CDC) regarding Covid. The compulsion to label anything one disagrees with "misinformation" has replaced the fire at the stake.
Medicine has always been extremely slow to adopt new methods of practice. All you have to do is read about Dr. Ignaz Semmelweis, a Hungarian physician who was an early pioneer of antiseptic procedures. Dr. Semmelweis was the classic example of the medical community denying inconvenient truths and destroying the physician who disagrees with current medical practice.
Dr. Simmelweis, an obstetrician, discovered that the incidence of puerperal fever, (fevers after childbirth) could be drastically reduced by obstetricians disinfecting their hands in obstetrical hospitals. In his day, women who delivered at home had a lower mortality rate than those who delivered in the hospital. His premise was that the young doctors would go from the cadaver lab to doing deliveries without washing their hands. He surmised that there was something termed germs or bacteria on the hands that spread to the patients. In his hospital, the maternal mortality rate was dramatically decreased when he implemented handwashing with dilute chlorine, still used today in daycares to wash the toys.
Whatever Dr. Semmelweis did, he managed to alienate his peers who were insulted at the insinuation that they might have something on their hands that they would need to wash off. So, the idea of bacteria was considered to be deranged, they could not be seen, and the fact that bacteria would be in their hands was insulting, so he managed to aggravate large groups of his peers. As a result, he was restrained physically, socially, intellectually, and was censored. He was placed in an “insane asylum” where he lived for a few weeks, but died from, of all things, sepsis due to a cut on his hand. He was 48 years old. Not a very good reception by his peers, considering the importance of his discovery.
Louis Pasteur, a chemist, born only four years after Semmelweis, had a similar idea about bacteria, but he managed not to aggravate his peers to the point of his destruction. He invented pasteurization, which kills microbes and prevents spoilage in beer and milk. His practices are still used today. He also invented vaccines for chicken cholera, anthrax, and rabies. He managed to avoid being sent to an insane asylum and being professionally burned at the stake, but he did have his critics.
Until about 1960, we had “insane asylums” and “crippled children’s homes.” Many inconvenient people were placed in these institutions. A few weeks ago, I wrote an article on gaslighting. Until relatively recently, women could be placed in insane asylums because their husbands didn’t like them, because they smoked, because they weren't submissive enough, or because the husband found a woman he liked better. Once the previous wife was placed in the institution, her rights were nullified, any property she might have would be confiscated, and a divorce could take place so that the husband could remarry. These were real concerns by some people even through the 1950s. The restraints of being locked up were physical, but with the widespread use of laudanum, the restraints were medical as well. I had a patient whose mother was very afraid her husband would put her away because she wasn't a good enough wife.
Laudanum is a solution of 10 percent opium powder dissolved in alcohol. It was widely used to treat everything from pain and insomnia to menopause symptoms, depression, anxiety, and even to quiet crying babies. In Victorian times it was used to “quiet” disturbed insane asylum residents. Laudanum was completely legal until the late 1800s.
A Time magazine article reviews the history of declaring women "insane" to lock them up in mental asylums. As Elizabeth, a housewife and mother of six, said:
“I, though a woman, have just as good a right to my opinion as my husband has to his….”
Could just as well have been said of physicians for expressing an opinion about medical care.
In the 1960s, prescription medications were used to keep housewives under control. Dexamyl, a combination of amphetamine and dextroamphetamine, was given to some women to alleviate “fatigue.” Another was valium (diazepam), a sedative and anti-anxiety medication. The Rolling Stones made a song about “Mother’s Little Helper”. It describes quite precisely what it did for housewives. These were a form of mind and thought control, or a physiological/psychological restraint.
During the late 50s and early 60s, with the ability to restrain the feelings, actions and thoughts of another with medications, the populations of the insane asylums were drastically decreased. It would, however, take another 20 years before the so-called "crippled children" were released from their physical confines and placed in community living arrangements. In North Dakota, this occurred as a result of a lawsuit by the Association for Retarded Citizens (ARC), an organization working to protect the rights of people with developmental disabilities. Judge Bruce Marion Van Sickle presided over the case in the early 1980s which emptied the state crippled childrens' institutions. At the time, the ARC sued the state of North Dakota for $83 million and won.
As a medical student, I had the opportunity to visit one of the crippled children’s homes. There were a lot of cribs, a lot of bars, (like prison) significant overcrowding, and a very bad smell. A few years ago, I listened to a patient who had three sons. On the first visit, she told me that her second son was beyond control and very embarrassing, especially when people came to visit. They placed him in the crippled childrens home. Occasionally, he would come home to visit his family and he would cry and beg his mother to let him stay home, but she always returned him to the crippled childrens home, where he remained until he died at the age of 26. So, mind control and the consequences of violating the prevailing institutional dogma is alive and well today, as any physician could tell you.
Today, the problems with dealing with demented patients often result in judgmental labeling. Dr. Sara Al-Zubi recently wrote an article on the problems of treating patients with delirium. Treating “temporary dementia” always caused problems for the medical staff. Actually, the better term for "temporary dementia" would be delirium which seems to come and go. According to Dr. Al-Zubi's article, 23 percent of all hospitalized patients have acute confusion with fluctuating attention and awareness.
Frequently a patient who is delirious will present to the emergency room with behavior changes and the patient will strike out into the air and pick at the air. Her article goes on to say that doctors don’t have to deal with this very long, but nurses do. She notes that sometimes physical restraints are placed on these patients because the nurses are afraid of them. Many nurses I know take this process personally, as if the patients are actually hitting or picking at them personally. Most of these patients have some form of delusion. They see something or they imagine they see something in the air.
Picking at the air is a sign, a very serious sign, of extreme illness or disease. In my experience, when somebody has an overwhelming infection, they will pick at the air and sometimes they will strike out, but generally they are not striking at anybody. Many of the nurses I know are always very quick to fill out a form called a “code pink.” This form records that they feel they are exposed to physical danger. Besides patients being physically ill, some patients present under the influence of alcohol, alcohol withdrawal, or drugs.
Years ago, when I was a med student, I was assigned to an elderly gentleman in the hospital who was having alcohol withdrawal, or delirium tremens (DTs). I bent over his bed with my stethoscope to listen to his heart. At that time we had a significant dress code, which included wearing a tie and a short white coat. The short white coat was to distinguish us from the residents or staff doctors who wore long white coats. But as I was listening to the heart of this patient with DTs, he grabbed my tie so tightly that he pulled me into bed with him. I did manage to escape without being strangled, but the tie, which was knit, was permanently misshapen and served as a reminder to me to be careful about getting too close to a patient with DTs.
Yes, these people high on something or withdrawing from something are agitated, strong, and can be very dangerous. Reviewing the fact that we are not supposed to physically restrain them, there is really only one thing you can do. Alcohol withdrawal is probably the simplest thing to treat with Ativan, which is a benzodiazepine. The absolute limit is less important than what it takes to get the job done. So, they should be given whatever it takes. Unfortunately, a lot of times you can’t get an IV in agitated patients and if you do manage to insert an IV, it doesn’t stay for longer than a few minutes. So, taking care of these people requires a lot of very coordinated activity. You want to keep them fairly well “snowed.” There’s absolutely no point in going through violent activity several times each shift. This is, of course, a form of medical or chemical restraint, but there is simply no way around it.
The goal of treatment for any of these patients, whether they are in some kind of withdrawal or whether they are very sick with sepsis due to a kidney infection, pneumonia, or some other infection is to treat the primary infection so the other symptoms will resolve on their own. Treating the primary problem will be the shortest distance between two points. Once the original condition is treated, there should likely be no more need for physical or chemical restraints.
Over time, most physicians acquire judgment. Judgment is a valuable skill in navigating uncertain situations where information is limited and experience or intuition are more important than technical expertise. Doctors, NPs, PAs, and nurses involved in the care of patients are in the best place to make decisions about patient care. Physicians are bound by protocols which often have little to do with a specific patient's care because no two patients are alike. When physicians are bound by national regulations rather than their own clinical judgment, patient care does not exist. And we’ve seen what happens when physicians are barred from making their own clinical assessments by treatments enforced or denied by national clinical regulations.
In the dysfunctional healthcare environment we have today, especially in medical care, judgment has really gone out the window. It has been denigrated on numerous occasions and has now been replaced by so-called evidence-based medicine, whatever that means.
Today our young providers don’t understand the freedoms and responsibilities they no longer have. Who is their master? Either they serve the patient, which has been the protocol of physicians in the past, or they serve insurance companies, and government rules, mandates, and protocols. Let there be no doubt about it; you can’t serve both. In our current dysfunctional healthcare system, patient care has taken a backseat to government protocols and mandates.
Our legislators need to free physicians from restraints on speech and freedom of thought. The remarkable censorship of the recent past needs to be resolved. Allow us once again to tolerate the thoughts and feelings of others. Time to stop burning physicians at the stake for thinking outside the box. As I have said many times in my posts, let doctors be doctors, even if their opinion is different than yours.
An estimated 39 TRILLION bacteria in our body, but some of them are bad ?