Tuesday, August 23, 2005

Bluntness v. Rudeness

There are distinct differences between bluntness ("The quality of being direct)" and rudeness ("A manner that is disrespectful and contemptuous)." The distinction has become blurred as we have become a nation of people who, as the Jack Nicholson line goes-"can't handle the truth." My job as a prosecutor puts me in daily contact with criminals and their families and with victims of crime and their families. I have learned the hard way that in this profession, the only way to deal with the demands and emotions of these disparate groups is by being blunt to a fault.

As a human instinct, all criminal defendants (i.e. anyone charged with any traffic or criminal offense no matter how minor it is) and their family members or friends who care for them or about their case, desparately want to hear positive news in any form or fashion. That instinct causes them to screen out all bad or non-good news and also translate any ambiguity or uncertainty into something positive. Equivocation is my worst enemy-it soon replicates into a ray of hope, then a promise, then a solemn oath. The word "NO" is completely unambiguous and hence is anathema to these people. Although it may be the correct answer to their inquiries or pleas, it is the surest and quickest way to be called "rude."

With victims, we are often the conveyers of bad news. It is difficult to explain to someone that the person who stole their car or who broke into their house or embezzled thousands of dollars from their small company cannot be sent to jail. Even worse are the families of those killed by a drunk or reckless driver when you have to advise them that even if convicted, no jail time for the person responsible is a possibility.
Our criminal sentencing rules are a function of available jail space. A first offender faces automatic active jail time only if he holds up a 7-11 with a gun or does something worse-anything less carries the possibility of probation. Not to editorialize on a matter that will not change in my career, (I like to say that I remember when breaking and entering were actual crimes), but to illustrate my point- that with victims also, being blunt about a case's outcome, is necessary, and not usually well received. The only thing worse than giving them the "criminal punishment reality check" is allowing a victim to grasp at unrealistic expectations. We always have to prepare them for the absolute worst thing that can happen and be as direct and blunt as possible-they too crave the good news and tend to block out the bad.

The article that spawned the above observation was linked over at Wizbang. It involves a doctor being reported to the state medical board for telling the unvarnished truth to one of his patients. Michael Kinsley, when he was editor of The New Republic, once opined that "a major gaffe only occurs in Washington when someone actually speaks the truth." It seems that eschewing the "truth" is no longer limited to that city. Here's the article:

Complaint over blunt words on obesity frustrates doctor
Union Leader Staff

MANCHESTER — Obesity is one of the biggest killers in America, leading to heart disease, diabetes, high blood pressure, stroke and some types of cancer.

Doctors have been warning their patients of the evil of being overweight for years, telling them to lose weight.

But now a New Hampshire doctor is under a regulatory cloud for very bluntly telling a female patient she is obese and needed to lose weight.

Dr. Terry Bennett, who practices in Rochester, said he has "an obesity lecture for women" that is a stark litany designed to get the attention of obese female patients.

He said he tells obese women they most likely will outlive an obese spouse and will have a difficult time establishing a new relationship because studies show most males are completely negative to obese women.

Bennett said he tells them their obesity will lead to high blood pressure, diabetes, heart disease, gastroesophageal reflux and stroke.

One patient who Bennett had seen five or six times took offense at the lecture and filed a complaint against Bennett about a year ago with the New Hampshire Board of Medicine.

Bennett says his former patient filed the complaint because "I told a fat woman she was obese. I tried to get her attention. I told her you need to get on a program, join a group of like-minded people and peel off the weight that is going to kill you."

He said he had discussed her obesity before with the woman, but she continued to put on weight, becoming diabetic with gastroesophageal reflux and chest pains.

"When I found out she was offended, I wrote her a letter apologizing and that should have been the end of it," Bennett said.

The complaint was initially investigated and reviewed by the board of medicine's Medical Review Subcommittee, which recommended to the board that Bennett be sent a confidential letter of concern. But the board rejected the suggestion at its Dec. 2, 2004, meeting.

Instead, the board asked the Attorney General's Administrative Prosecution Unit to investigate and seek a resolution to the complaint. A settlement agreement was proposed that would have had Bennett attend a medical education course and acknowledge he made a mistake. He rejected the proposal.

"I've made many errors in my lifetime. Telling someone the truth is not one of them," Bennett said.

A public hearing is likely to be scheduled by the board.
Policing doctors

The board of medicine's Web site says that state law authorizes the board to take disciplinary action against physicians who engage in providing false information, practicing medicine while impaired, behavior that is incompatible with basic knowledge and competence, dishonest or unprofessional conduct, negligence, allowing an unlicensed person to practice in the physician's office, failing to provide aseptic safeguards, dishonest advertising or statements, willfully violating the Medical Practice Act or if convicted of a felony.

"Complaints regarding high fees, rudeness or 'poor bedside manner' do not ordinarily violate one of the above provisions unless they also involve dishonesty or exploitation or gross negligence on the part of the physician," according to the Web site.

"To me this is much ado about nothing," Bennett's attorney, Charles Douglas, said. "If the board wants to get into policing how doctors talk to their patients, they are going to be very busy."

Douglas said he has had clients not like what he told them or the way he told them, and he apologized when he found out they were upset. That should not be a disciplinary matter, he said.

"Terry's an old-fashioned doctor who will see anybody if they have money or not, or if they are on Medicaid. He's the last independent doctor not owned by a hospital in Strafford County. He's not going to roll over on this, he is going to fight," Douglas said.
Going public

Under the statute governing the board and its procedures, the complaint is confidential until a public hearing or an agreement is reached. Bennett said he decided to go public with his case because he is furious about the complaint and the way it has been handled by the board and Attorney General's Office.

"I've been a physician a very long time. I have never raised my voice. I have never lost my cool. I work hard at it and it wounds me deeply that I made her angry. These things are very disturbing to me. I am heartfelt sorry that I wounded her. I wanted her to change her life," Bennett said.

Dr. Bruce Friedman, chairman of the board of medicine, said "The board has a process that examines all complaints. The board will look at any complaint and decide if it has any merit or not."

He said the board tries to remain impartial, particularly if a complaint results in a adjudicative hearing.

Friedman said he could not discuss specific complaints but did agree that obesity is a major concern. He said some doctors work harder than others on the issue with their patients.

Assistant Attorney General Catherine Bernhard, who conducted the investigation, said "I can't acknowledge anything," and referred to RSA 329, the statute that governs the medical board and its procedures. It states that complaints are confidential until the board takes disciplinary action.

Penny Taylor, administrator for the Board of Medicine, also said she could not confirm any complaint before the board.

She did say the board receives about 20 to 30 complaints a month. In quite a few instances, no action is taken, she said, and few go to a public hearing. The cases are usually settled before a complaint goes to a hearing, she said.
Patients rally

Many of Bennett's patients have rallied to his defense, signing petitions and writing letters on his behalf and sending them to the board, Attorney General Kelly Ayotte and Gov. John Lynch. They are also willing to show up at a public hearing to support Bennett.

Melinda Haney of Rochester has been Bennett's patient for 15 years. She had more than 100 people sign a petition asking Lynch not to re-appoint Ayotte as attorney general because of the investigation.

Like the woman who filed the complaint, Haney is obese.

"For 15 years Dr. Bennett would tell me 'Mindy, you're overweight and you smoke,'" she said. " 'You are going to get diabetes or cancer or have a stroke or heart attack.' The whole time I was saying 'Yeah, yeah, yeah, I'm young, those things only happen to someone else.'"

She said now she is a diabetic, has had cancer and failed a stress test terribly.

"Is he a fortune teller? No. He was a man trying to do his job. Whether I wanted to hear it or not, he was telling me the truth. All those things that happen to other people happened to me."

Haney said a lot of things Bennett tells people are upsetting.

"I would not want his job. He's the messenger and people are always out to shoot the messenger," she said.

She said Bennett is the most compassionate doctor there is. A lot of people who signed the petition, she said, just don't understand why the attorney general is spending money to investigate. "We can't lose him because someone doesn't want to hear they're obese," Haney said.


Anonymous duzzimadder said...

hawai felon here. no money or property stolen, person harmed. life sentence: no job, welfare (how does the state justify this?), and even though i have just about zero criminal qualities, like many of the drug war casulties, next to sex my biggest fantasy is getting rid of this 10 year old criminal record and start living again. either that or rob a bank. any criminal support groups?

4:31 PM  
Anonymous Junior said...

This can't truly have success, I feel this way.
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6:36 AM  

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