In the U.S., nothing brings out the policy wonks like the subject of health care. The profits of the health care industry have been soaring, while the legions of uninsured has reached a staggering 48 million.

One under-explored angle on this problem is the culture of rankism that infects the medical community and plagues the major health care organizations in the U.S. While Britain has engaged the medical community in a public discussion of physician-on-physician bullying, similar concerns in the U.S. have been downplayed. However, the U.S. public is slowly coming to realize that dysfunctional administration profoundly influences the delivery of health care and leads to many unnecessary deaths every year.

Interestingly, the controversy over investment in a national EMR, has opened a wedge between traditional physician interest groups and the advancement of technology, which has allowed a few mavericks to break ranks and debunk the myths that have granted the MDeities fate-making powers over those in need of medical care.

Mounting evidence of medical student abuse (particularly in regard to women), suggest that subjection to hazing in medical school shapes physician attitudes about rank and entitlement later in their career. As long as rankist practices and traditions remained hidden behind the cloak of “professional matters”, there could be no public comment on the gross social and organizational distortions created by physician culture. Now, as the death toll mounts, it has become evident that medical student abuse and endemic rankism in health care organizations are problems that demand public attention and legislative oversight.

I just read a terrific article on mobbing. I learned that the term mobbing comes from ornithology:

Every so often birds in a flock will turn, as one, on a perceived threat (either outside, or inside their group) and harass some luckless victim into flight or exile. It often seems less a response to genuine danger, than a reflexive action making for collective cohesion (”we’re all in this together - except that bastard over there. Let’s get him”).

In an academic context: “mobbing is a way in which academic groupings - departmental or sub-departmental - create reassuring solidarity and togetherness for themselves.”

The most interesting observation touched on the irreversibility of the acts that feed the moment of mobbing: “But a spotlight is now constantly directed on the mobbee. In its glare, very few people can maintain impeccability. Any lapse is seized on as confirmation. The dossier swells. It never shrinks.”

Recently, I’ve seen attempts to make the ex-president of Harvard, Lawrence Summers, the posterboy of mobbing. I just can’t buy that because Summers used (abused?) his position as the leader of an elite institution to push out others, and degrade women as a group. Sometimes it’s hard to tell mobbing from democracy, but I would say that when someone has long benefited from leading the mob, and he’s finally on the receiving end of a sorting out - that’s probably democracy.

Also, I wouldn’t want to see mobbing used as a shield by the corrupt leadership of the University of California.

The people who are really vulnerable to mobbing are those at the bottom, those who people don’t give a second thought about after they’ve been “disappeared”. I wish there was more high profile media coverage focusing on them. I want to hear about the file clerk who was mobbed - perhaps to preserve group solidarity based on sex, race, or religion.

Online, I’ve seen many cases in forums where the group leader (a “moderator” or an “admin”) signaled open season on a target, and hordes of people who were just passing by will jump in on the pile-on with obscene glee.

Mobbing is also a form of rankism. Instead of a high-ranking person abusing their power, mobbing is about abusing group authority. Members of the group are granted rank to enforce the “general will”. The result is the opportunity to release frustrations that have been suppressed in other areas. This sort of bloodletting reveals all that is horrifying about human nature. Hopefully the problem can be mitigated by education and social consensus.

One of the tricky things about the U.S. legal system is that people have to arrange their grievances to fit the existing law. The woman who won a $500,000 judgment against the company that spanked employees deserves every penny. However, it should give us all pause for thought that the lawsuit had to be constructed around sexual harassment. Are we really missing the legal foundations to defend workers against deliberate humiliation by superiors? Why wasn’t this a class action suit?

If the results from a University of Maine study can be construed as representative of university life in the U.S., more than one in five students have witnessed hazing. A quick glance at the news reveals a surprising number of hazing incidents (including the hazing murder of an Iraq veteran), and efforts to protect the victims through enlightened policies and legislation. Here is a good general resouce on hazing.

Apart from protecting the victim, I think the high numbers of witnesses who apparently do little or nothing call for a renewed public discussion about the bystander effect. This is a difficult topic to bring up, especially if you’re trying to point out and prevent the Bystander Effect in progress. In my experience, anyone who is part of the Bystander group will have a knee-jerk defensive reaction to the implied accusation rather than using the information to redirect their attention and help the victim. Perhaps what we also need is a social pact that makes it safe for people to bring up a Bystander issue: i.e., no hostility, retaliation, ostracization, or attempts to turn the group against the person who dares to point out Bystander behavior. The Bystander Effect is real, and a quick glance at all the news stories about hazing shows that people are getting hurt and even killed because of the social obstacles to intervention.