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Who is to Blame for Our Unbalanced Medical Environment and Who Is Going to Fix It?

This post is the second in an ongoing "CEO Article of The Week" original content series written by Integral Leaders in Health Founder and CEO, Spence Taylor, M.D. New articles on various topics related to our organization's purpose will be published each Monday.

South Carolina is experiencing a medical care crisis where patient well-being is no longer the top priority, and the components of the medical environment (doctors, hospitals, payors and universities/innovators) seem unbalanced and patient dissatisfaction is at an all-time high.

So, who is to blame? Someone must be responsible and should be held accountable? Right?

Blaming and complaining has seemingly become our national fixation. It is fascinating to have conversations with patients who have had a bad medical care experience. Besides being passionate and angry, they invariably assign blame for their dissatisfaction to some component of the medical care environment. The Affordable Care Act gets a fair share of blame in South Carolina. Hospital mergers also commonly get tagged as the perpetrator too. Both are usually deemed as villains within the crisis. Doctors, on the other hand, are often portrayed as victims of burnout in a system of inefficiency. Universities/Innovators, too, can feel victimized at the effect of hospitals for their not wanting to share their clinical environment for teaching and research. Victims, in general, usually seek heroes to save them.

The government is a most logical place to turn to for such a hero. For example, our elected officials who are chosen to look after us. But wait a minute, don’t people also see the government as part of the problem?

As a result, elected officials feel victimized and blame the hospitals, who in turn blame the doctors. The doctors now become the villains, who turn to the patients for help, who now become the heroes and who, in turn, blame the hospitals who blame the universities for not making enough doctors and blame their learners who add inefficiency to the environment. In other words, the universities are now the villains, who suddenly feel victimized in need of a hero (perhaps the doctors will hero them). And so it goes, on and on, like the plot of a bad mystery movie where there are a dozen twists in the last five minutes that make no sense.

In 1968, Dr. Stephen Karpman, a then psychiatry medical resident, published an observational study called “Fairy tales and script drama analysis” in the Transactional Analysis Bulletin. In it, he described human behavior occurring in what has become known as the “The Karpman Drama Triangle,” shown below:

The Karpman Drama Triangle, described by then psychiatry medical resident Dr. Stephen Karpman in "Fairy tales and script drama analysis," 1968.

The victim-villain-hero scenario described above is a perfect example of the Karpman Triangle. Notice the feeling of drama that emanates from the discussion -- a feeling of injustice, fueled by blaming and complaining. Notice the reactivity as well. Blaming, as illustrated by the Drama Triangle, is always a symptom of a reactive posture—an “innocent’ victim at the effect of an aggressive perpetrator reacting— crying out for a rescuer. Reactivity rarely solves anything. It just produces drama. Notice in the scenario how nothing changed; nothing got fixed. Reactive posture almost never produces change. It is only creativity that results in healthy change—in improvement. The point here is to resist the urge to blame any one component of the medical environment for the Medical Care Crisis.

The components are not broken. They are out of balance.


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