Changing the System: Medical Mistakes and Unprofessional Behavior
My visitor who wrote the e-mail I last posted, sent me a follow-up e-mail continuing with the concern about medicine's current tendency to hide, cover-up or fail to report medical error and unprofessional behavior. The visitor wrote:
The system must change. Doctors must feel free to chart mistakes. When a doctor feels pressure to avoid documenting the result of poor care there is a problem. When a doctor feels pressure to lie about providing medical interventions that were not provided there is a problem. When other doctors feel the need to support lies, either to protect a less skilled doctor or to avoid getting dragged into a messy court case, there is a problem. When nurses do not feel free to report unprofessional behaviour or medical mistakes there is a problem. At my local hospital nurses were told to stop complaining about a doctor who was behaving strangely. They were told they would lose their jobs if they continued to complain. The result? The doctor died of a drug overdose in a hospital washroom moments after overseeing an operation. The problem was so bad it was common knowledge around town that this doctor was not performing well, 3 months before he died. Even if the system doesn’t care about the quality of care patients are given, in this type of situation, the system should at least care about helping the doctor. This doctor had two young children and a wife. The problem of covering up mistakes or unprofessional behaviour stems from the fear of being sued or looking bad. As human beings we should be able to rise above a cycle of lying and suing and move toward providing a safe healthcare environment.
The Heath Council of Canada is looking at a New Zealand model of no-fault healthcare insurance to encourage a more open, honest system of reporting problems. Or for an example of how long it can take a patient to get the medical system to take a complaint seriously, and the damage inflicted on other patients when the goal is to cover up problems, check out this example. If I recall this problem was not addressed until a patient went to the press for help.
You may have noticed that this topic of medical error and unprofessional behavior has been a repeated subject on my blog. There is reason to keep this problem on the top burner when medical ethics is being discussed because of its widespread presence and its profound impact on patient care. Perhaps my visitors can contriubte suggestions to help with its solution. ..Maurice.
posted by Maurice Bernstein, M.D. @ 10:14:00 AM
8 comments
8 Comments:
This is pretty simplistic, but when I read about those complaints, all that comes to mind is that medical personnel are afraid to do what they know is right - primarily because of legal repercussions.
Medicine no longer is in control of medicine. Lawyers are. The government is. Big pharma is.
I'd like to fault the medical professionals for letting it get this bad ... but really, we're all to blame. We all let it happen, and we all continue to allow it to happen.
When physicians can begin to practice medicine according to their consciences again, with no outside pressures other than what their patients bring to bear on them, I think that a lot of these questions will become moot.
For the time being, there will be people with weak backbones in every walk of life - including in the medical world. Gaining an MD or a DO doesn't guarantee that the individual also gains a backbone, and the common sense necessary to use it properly.
People are just that: people.
Patients have no choice but to hand over a great deal of power and, therefore, trust to doctors. The relationship is such that the patient, for the most part, is at the mercy of the doctor while under his or her care. This should mean ‘something’ as far as the level of protection the medical community is willing to provide in trade for that level of power and trust. “People are just that: people.” However, in some cases a person takes on a position that elevates what is expected. I enjoy my neighbours as people. However, if I suddenly had to put this degree of trust and power into their hands I’d want an understanding that they were no longer free to subject me to the down side of human nature.
In the example case from Ontario, at all levels the medical community was missing a backbone. This would indicate that being spineless is the norm, rather than an exception. In the video clip, from the site, even the janitor states that she was aware this doctor was a problem and tells a patient…”I’m not supposed to say anything but…” Clearly, even janitorial staff understood that mistakes get filed away into the ‘code of silence’ file. The time frame, close to a decade, also suggests that this was the accepted approach, rather than a one time event where all levels circled the wagons to cover up for one bad apple. It was habitual/a reflex.
I’m sure this case is not as unusual as the public would hope. I base this belief on the fact that everyone knew their job was to remain silent even when patients complained. This level of cover up takes practice and a deliberate mind set. I cannot imagine the emotional pain a patient is subjected to when discovering that they don’t even have the power to protect others from what they were subjected to. Imagine knowing a dangerous person is in a position of trust and is, in reality, causing harm. Further, that the safety net constructed to protect patients is actually constructed to protect the dangerous person. In everything I’ve read, pertaining to the complaint process, the message seems to be that it is rare for one doctor to speak out against another doctor. With 1 in 13 patients in Canada experiencing a problem, related to the care they were given, if providing good care was the goal far more doctors, simply based on the odds, would support patients in the complaint process. It certainly appears that even the good people in healthcare are willing to remain silent.
Actually this happens in many other disciplines as well, from corporate business to the news media. To say it's all due to fear of legal repercussions is way too simplistic.
People don't like to fess up to their mistakes because they fear being judged harshly, they fear their career might be damaged, they fear their pride or reputation will be harmed, they're embarrassed or ashamed, etc. etc. etc.
It's worse in medicine, of course, because the consequences of an error in judgment can be so devastating to the patient, plus the physician ethos is all about high standards and personal responsibility.
I've experienced medical injury. The worst thing about it was the absolute refusal of anyone to acknowledge how distressing it was, let alone take responsibility or - God forbid! - sit down and discuss what happened. I can understand why; I understand the psychology, the dynamics and all of that. But it's still incredibly callous and arrogant and condescending for physicians to push a patient through surgery to correct the damage from their error and not even tell me what's going on - as if I'm too stupid to notice.
If physicians want *us* to change, they have to be willing to make some changes too.
Its not callousness or arrogance, although many physicians do have an abundance of those qualities. Its that physicians can't risk what you are asking of them; their careers could be on the line.
I'm experiencing it first-hand in trying to hold the hospital and doctors that mistreated my father accountable for their actions. There is indeed an unwritten code of silence throughout any local medical community.
http://users.starpower.net/neustadter/menu.html
I have an idea. Videotape all hospital encounters, from the operating theatre to the hospital room visit. Sure, doctors might at first be reluctant, but consider the money they would save in insurance premiums if there were no misunderstandings, no he-said-she-said situations, no need for expert witnesses to second guess what may have happened, no need to fear false or frivolous lawsuits. I'm starting not to see much of a downside to my suggestion.
Anonymous from July 5,2006, your idea is being carried out by some physicians in the United States. My experience is noting that physicians have tape recorded their conversations with the patient regarding the informed consent for surgical and other procedures. I would say that if the physician doesn't do this, the patient should bring in a tape recorder. Knowing that the meeting is being recorded for later review should encourage the physician and the patient to be more thorough and open in their conversation in order to prevent ambiguity of what was said. Also, I have seen surgeons video tape recording the operation, with step by step explanations and present a copy of the tape to the patient. There should be no excuse by the physician not to allow these recordings since they would clearly serve to prevent "Doctor said-Patient said" conflicts, something both parties would find valuable for their own interests. ..Maurice.
Very worried about what is going on in the medical community. I was a victim of a cover up. It is sad to know the extent people will go to cover up as to not be held accountable. My story is very nightmarish and many people would find it truely sicking to know what was done. If their is any way I can stop this from happening to others I will try my best.I still don't understand how someone could leave a person in that condition and make it look like they are crazy. The illness I had cause a psychosis so it was very easy for them to do. I only hope others did not become sick as well because what I had can be spread to others and whoever I made contact with needed to be medicated.
Anonymous from today Sept 26th, perhaps it would be helpful for you to discuss the entire situation privately with a physician who is totally unknown by your previous physician. He or she may help you work out your concerns about your previous diagnosis and treatment. I would not recommend returning to your previous physician. ..Maurice.
GB wrote the following today ..Maurice.
Surgeons made a medical mistake with my hernia surgery. Instead they took off my stomach muscle.All doctors and authorities cover up for their mistake. I lost out on a Government LTD pension because of the lies.Resulting I lost all trust in the medical proffession.
GB
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