NYU physician -- Charles Cullen killings result of widespread materialism, no compassion
April 30, 2004 -- In an op-ed piece published today in the Philadelphia Inquirer, "Nursing compassion to health," NYU forensic psychiatrist Michael Welner argues that nurse Charles Cullen's patient killings were the result of the modern emphasis on "material" benefits in the training and hiring of hospital workers. To prevent such events in the future, health care facilities should "focus on hiring those with the most compassionate personalities." Leaving aside the spectacle of a physician who is Chairman of The Forensic Panel ("America's foremost forensic consulting institution") lecturing nurses about greed and compassion, Dr. Welner's piece shows little understanding of the life-saving professional skills required of modern nurses, or the effects of nurse short-staffing, inadequate resources, and systemic problems in end-of-life care on adverse results in clinical settings.
Dr. Welner correctly notes that managed care has often meant enormous patient loads for nurses and others that lead to "social and personal" issues being short-changed and "assembly-line illness management." What he does not seem to realize is that nurses in this environment are not just unable to address social and personal issues. They may not be able to monitor complex aspects of patient conditions, to intervene to prevent death or disability, to educate patients and families about how to deal with illness and return to health--in short, to save and improve lives. Even so, we might have expected Dr. Welner to propose a different allocation of resources in the health care system, in order to free nurses and other hospital workers to provide whatever care he thinks they provide.
Instead, Dr. Welner places the blame on the nurses and other clinicians themselves, and on the training and hiring practices that have produced them. In his view, apparently, Cullen was not an aberrant sociopath, or even someone with a misguided response to real problems in end-of-life care that leave too many terminal patients suffering needlessly. Cullen was just an extreme example of what modern nurses have become in an era when compassion is undervalued. Dr. Welner explains:
"Employment ads solicit health-care workers based on material benefits. Whom, then, will such ads aim to attract? Not the nuns of yesteryear. Greed and materialism characterize contemporary culture more than civic-mindedness does. So we need to integrate vigorous empathy training and stress management into medical and nursing education. ... Tomorrow's professionals need to be prepared for the adverse climate of providing health-care services within institutional frameworks that are insensitive by design. Only then will the forces of kindness balance those of callousness."
This defies belief. The answer to "insensitive" care systems (and the occasional sociopathic care giver) lies not in restructuring health care financing, more support for health care professions or better oversight, but simply in hiring nicer people with better stress management skills! If only the "nuns of yesteryear" were on the job, the problems of short-staffing would disappear, presumably because the compassionate can do the work of 10 people. Nurses just need to remember their "angel of mercy" heritage. Of course, this line of thinking is a threat to nurses and patients everywhere, as it ignores the fact that nursing requires years of college-level training and extremely hard work, and plays into age-old stereotypes of nurses as unskilled spiritual beings who don't need the respect and material resources on which other professions rely to insure high quality performance. Of course, compassion is an important part of nursing. But if given the choice between a kind angel and a professional who has the skills and resources to keep us alive, as Buresh and Gordon say, we'll take the professional.
The Center could not resist a brief look at whether Dr. Welner's focus on "compassion" and selflessness in health care recruiting extended to his own lucrative New York consulting practice, The Forensic Panel. We note that each of the Panel's consultants holds an M.D. or Ph.D degree, and that its web site describes them as follows: "Panel specialists are clinicians first, teachers second, and expert witnesses third. Each member is board certified, academically affiliated at a highly respected institution, and distinguished as a Director, Chairman, Associate Professor or higher rank. The Forensic Panel was founded by Michael Welner, M.D., a preeminent forensic psychiatrist at New York University School of Medicine." However, we saw nothing in this credential-fest about compassion or non-materialism, and we are at a loss to explain the oversight, given the primary role Dr. Welner would assign those qualities in the hiring of nurses and other hospital care givers who have apparently become lost in excessive materialism. The site does not neglect material concerns, however; one of its "FAQ"'s helpfully addresses the no doubt vexing question: "How can I afford the services of the Forensic Panel?"
The Center urges all nurses to provide Dr. Welner with feedback as to his apparent view that the key to addressing the problems of health care serial killing, managed care and nurse short staffing is a renewed focus on compassion in nursing, as opposed to better oversight systems, professional development, and the allocation of adequate resources to clinical practice and education. We suggest that Dr. Welner find ways to promote his consulting business without resorting to uninformed, regressive drivel that, at best, does nothing to promote better health care.
See Michael Welner's op-ed: "Nursing compassion to health" in the April 30, 2004 edition of the Philadelphia Inquirer (requires free registration).
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