Earlier this year, we submitted a proposal for a book chapter in the book under the working title “Patient Centered Medicine “, ISBN 9789535149828. Our proposal was accepted, and we just submitted our draft chapter with the working title, “Patient-Centered Medicine and Prevention of Munchausen Syndrome by Proxy”, or MSbP.
The chapter covers the following topics:
- Understanding the nature of MSbP: This section describes the entity “MSbP” as seen from a patient-centered perspective.
- How the healthcare system contributes to MSbP morbidity and mortality from a system perspective: This section describes how the healthcare system appears to operate in MSbP cases in ways that contribute to patient and perpetrator morbidity and mortality.
- How the healthcare system contributes to MSbP morbidity and mortality from an individual perspective: It is generally considered that the healthcare system’s contribution to patient and perpetratory morbidity and mortality in MSbP is due to the innocent actions of those within the system. However, there are important cases where individual providers within the healthcare system are engaged in MSbP behavior; this aspect is covered in this section of the chapter.
- Recommendations for a patient-centered approach to MSbP in the healthcare system: This section applies the Haddon Matrix as a framework for structuring public health recommendations on how to address MSbP in the healthcare system. It focuses on changes in policies, regulations, and operations in the healthcare system to de-incentivize participation in MSbP behavior and incentivize the immediate intervention into suspected MSbP behavior.
Does our chapter sound boring? Good!
It provides a nice counterpoint to the drama in the scientific literature that has been much sound and fury, but signified nothing in terms of improving the identification of victims and their immediate protection.
Our chapter actually makes some solid, workable recommendations that could be built into the system, such as:
- Supervised collection of laboratory specimen so as to identify if the perpetrator is contaminating the specimen
- Federal regulation of the troubled teen industry (TTI)
- Requirement for hospitals to have a protocol of what to do if a provider is suspected of MSbP behavior, with a separate protocol of what to do if a patient or family is suspected of MSbP behavior
- Education of provider types likely to encounter MSbP behavior (such as adolescent psychiatrists, emergency department personnel and pediatricians) as to red flags indicating MSbP behavior
These might be a long shot, but you can’t reform the system without any concrete, workable reform proposals on the table. I think this is the first one I’ve seen that could actually be implemented.
Our next steps are:
- Hear back from publisher: To cross our fingers and hope that our chapter is reviewed and accepted for the book. We’ll update you in 6 to 8 weeks when we hear.
- Share our findings with you: Regardless of the chapter’s acceptance, I plan to have us make a series of blog posts about what the chapter says so you all know. I’ll try to make it less boring for this audience!
- Follow-up chapter – about “why”: We want to write a follow-up chapter (if the opportunity arises) to describe why we are making these recommendations, and why there have been barriers to intervention in healthcare about MSbP (where there haven’t been with, say, domestic abuse). Kent has written something we hope to publish about “affirmative bias” (assuming that “a mother would never do that”), and Mariel has brought up points about the dysfunction of the healthcare system on other fronts (such as fragmentation) lends itself towards unwitting (or witting) participation in MSbP behavior. C.E. Miller has experience within the healthcare system to inform this discussion, but it simply couldn’t fit in this book chapter, so these concerns needed to be kicked down the road to the next book chapter.
- More weird science: We also hope to get some journal articles published and go to a scientific conference together. We’ll keep you posted! We can always count on Mariel to take great pictures.
Do you have any topics about MSbP that you think the Proxy Project should explore?
If so, please comment below! We’ll see what we can do.