Journalism in the Public Interest

Five Takeaways: Why Doctors Stay Mum About Mistakes Their Colleagues Make

 As I wrote this earlier month, doctors often know when a patient has been the victim of a medical error – sometimes before the patient does.

But too often they don’t say anything about the mistakes, according to a recent report in The New England Journal of Medicine. Feedback to the post was so thoughtful that ProPublica decided to host a Google + hangout about the topic. We invited four experts to join us – two doctors and two patient advocates.

Here are five takeaways from the conversation.

1. The stakes couldn’t be higher for patients. 

Patient advocate Patty Skolnik said that when her son went into surgery, a young doctor who disagreed with the need to do the procedure excused himself from participating but did not say anything to her or the surgeon about the surgery being unnecessary. Her son later died because of injuries sustained in the surgery. Because of the doctor’s silence, “We lost a child,” Skolnik said. So conversations between doctors about medical mistakes can be issues of life and death, she said.


2. Doctors know this is a problem.

Dr. Tom Gallagher, an internist and professor at the University of Washington School of Medicine and lead author of the NEJM study, said he has given more than 200 presentations to doctors about patient safety problems. He said the most physicians often ask him about mistakes by colleagues. “I understand I need to tell the patient about my own mistake,” Gallagher said the doctors tell him, “but what am I to do if I’m aware of a mistake that a colleague has made involving the patient that we’re caring for together. Should I say anything to the patient?”


This uncertainty suggests that doctors too often stay quiet, which means patients are kept in the dark and opportunities to learn and improve the quality of care are lost, Gallagher said.


3. Doctors stay silent for many reasons.

Gallagher said that doctors who suspect a colleague has made a mistake may be uncertain about what happened. They worry about having an awkward conversation with a peer, or about causing a lawsuit or losing a business relationship. Dr. Brant Mittler, a cardiologist and attorney who also represents doctors, said the way doctors review one another’s work is often political. Doctors who have complaints filed against them may be unfairly treated during peer reviews, he said. “The threat of professional ruin is enough to keep doctors from confronting their colleagues,” he said.

Staying silent often means that patients have a hard time getting the care they need after they’ve been the victim of a medical error, said patient advocate Helen Haskell, whose son also died because of a medical error. “When there’s been harm, patients are bounced from one doctor to another trying to find care,” Haskell said.


4. There is a way forward.

Gallagher said the rights of patients and families are more important than the fears doctors have about difficult conversations. As such, physicians are obliged to explore potential errors with their colleagues, not ignore them, he said. The commitment to addressing physician errors directly is also the responsibility of the leaders at medical facilities, he added. “Ultimately we’re calling on physicians and organizations to recognize that accountability and transparency is truly a shared responsibility,” Gallagher said.


5. Putting patients first is a moral and ethical issue.

“Patients are the ones who are putting their lives on the line and the ones who are footing the bill,” Haskell said. They have a right to expect the services for which they contracted.

Skolnik said patients have a right to hear the truth from their doctors. Patients understand that doctors sometimes make mistakes, but they need to be told what happened and what’s being done to keep it from happening again. There’s no wiggle room for doctors, she said.



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Doctors who have complaints filed against them may be unfairly treated during peer reviews

I admit that it might be me,but I feel like someone doesn’t understand what “fair” means.  If you’re screwing up and you’re treated as if your performance is problematic, that’s the very definition of fair, where I come from.

If I might draw a somewhat naive conclusion by piecing together several things at once, it looks like Mutually Assured Destruction:  Doctors won’t talk about their colleagues’ failures because they don’t want their colleagues talking about their failures.  They consider that more important than the fates of patients.

Here’s the real problem, though:  If these issues aren’t discussed and tracked, they’ll never get better.  Everybody makes mistakes, but if the same mistakes are being made, then the medical industry is failing to move forward and everybody involved should be out on the streets.

Seriously, imagine if Pintos were still bursting into flames because, oh, y’know, we don’t want to have the hard discussion with the engineers and make them feel bad.

Given the taking of life or crippling a defenseless, vulnerable person is a crime, covering it up is a crime, obstruction of justice by silence, the silence it’s self is by definition criminal negligence.

The black and white difference between human “error” and criminal negligence is as self apparent as gravity.

Hospital administration knowingly condone criminal negligence in not only medical care, but is the unspoken curriculum in medical universities.
By the time many medical students become “full fledged” providers, many have already compromised their personal and professional integrity by being “extorted into participation” in criminal obstruction of justice by the very medical university administration policy of complicity in obstruction of justice “At the very least”

Part of the Hipocratic Oath ” Do no harm ............ ” .

Physicians who blow the whistle on problems with their institution (hospital) or other physicians face severe punishment. Whistleblowing physicians can be banned from their professional organizations and sometimes lose their licenses to practice medicine in a state. They often have to move to different states in attempts to start their practices over. Even that does not always work.

Lee Tilson

Nov. 20, 2013, Noon

Physicians who blow the whistle on problems with their institution (hospital) or other physicians face severe punishment. Whistleblowing physicians can be banned from their professional organizations and sometimes lose their licenses to practice medicine in a state. They often have to move to different states in attempts to start their practices over.
Even that does not always work.

The primary reason for a cover-up mentality is they’re risk management companies and associated attorney’s recommend against it.  Nurses and office managers and hospital managers also play a key role.  The medical culture is created by the risk managers. 

Risk management software and counseling that targets individuals based on their risk profiles leads to the rude behavior that many patients experience.

The reasons Marshall gives for physician silence is what the health care public relations/legal complex want people to believe but it couldn’t be farther from truth.  These false reasons allows the current system of physician blame and insurance company and hospital administration complete lack of responsibility to continue.  This system is favored by corporations because it allows them to make more money by reducing the quality of the care and when caught they can blame individuals within the system as opposed to systemic problems which make the system unsafe.  Perhaps the biggest systemic problem is the public relations legal determined medical culture.

As a direct result of the American medical establishment having allowed control over patient care to be hijacked by the insurance industry, the pharmaceutical industry, and government bureaucrats, all medical doctors (and often physicians’ assistants) are considered “competent” to dispense all forms of mind-altering medications, regardless of their fields of training and practical experience. I submit this expectation of our medical doctors is bad for them, bad for the medical establishment, and most of all, bad for overall patient care throughout America. As an example, the FDA recently reported that between 1990 and 2010, the number of deaths in the country from narcotic prescription drug overdoses alone has tripled.

Therefore, I suggest that all physicians should avoid any long-term prescribing of any psychotropics, anti-depressants, mood-swing drugs, opiates, benzodiazepines, narcotics, and all other forms of state controlled, mind-altering drugs, without the assistance of, or the outright referral to a psychiatrist. You may say, “Why? Everything we do is blessed by the AMA and is consistent with the ‘reasonable standard of care.’” That is correct—for now. However, the “reasonable standard of care” is always subject to change. And change often comes about as the result of legal pressure placed upon our institutions by trial attorneys who see a problem, and seek to remedy it through the only medium that these institutions and the marketplace truly respect—money. “‘Avarice’ [may be] the root of all evil”, but it is also the fuel for the engine of reform.

Elizabeth LaBozetta

Nov. 29, 2013, 8:41 a.m.

I have a solution suggestion: Just tell the absolute truth—always. And let the chips fall where they may. Time to grow up and take responsibility like viable adults! People who never lie do not have to remember what they’d said. They also do not have to go through all the machinations of concealing what has actually happened. Just tell the truth and offer to fix it, or at least try to fix it. That way both sides of the relationship can come away from the incident with their dignity and respect intact. And the injury victim may not like what he/she hears but they can say: “at least my doctor did not lie to me!” and “at least my doctor did not deliberately compound my suffering.”
It isn’t the injuries that make the victims most angry and causes us to lose trust and respect—it is the scripted concealment process and the smirking evil that goes with its delivery. It is the smirking evil that makes us want and seek revenge. Nobody likes to be lied to and cheated. Why does that come as a surprise to those doing it?
And anyone who has been exposed to the reality of how the legal system actually works knows that the excuse of a “threat of causing a lawsuit” as a reason to keep silent is ridiculous. That avenue of relief is effectively manipulated closed to most medical malpractice victims.

This article is part of an ongoing investigation:
Patient Safety

Patient Safety: Exploring Quality of Care in the U.S.

More than 1 million patients suffer harm each year while being treated in the U.S. health care system. Even more receive substandard care or costly overtreatment.

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