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It's a path
If you wanted to understand conditions in prisons but never listened to prisoners,
you would be ignoring the most important voice.
Remember the tobacco company executives who testified under oath that they did not think that tobacco was addictive or bad for people? Self-serving self-delusion is as prevalent in medicine as it was in tobacco. Yet our information about patient safety comes from people in healthcare. There is no appreciation of how prejudiced that information is. That information is no better than what we learned when we got our information about smoking from tobacco company executives.
So we don't get information they don't want us to get - information as basic as the crime rate in medicine, or even that there is one, let alone where the problems are and who the problems are. We don't learn what to do when we or people we know become victims of error or abuse in medicine. As a country we are not even aware of the size or the cause of the worst patient safety problems. It is not in the interest of healthcare workers to know about that themselves. What we do hear about are the problems providers have with patients making it sound as though medicine is expensive because of frivolous suits. Just go to the White House's web site and read what they have been lead to believe the problems in medicine are and what they support as solutions.
"Any time that people are forced to acknowledge publicly
that they are wrong, it is really good for the commonweal."
- Stewart Brand
From the perspective of healthcare professionals, lawsuits are a big problem. They believe in themselves. They don't believe patients. They believe in the people they work with. They have faith in in their own goodness. Bad outcomes get redefined so as not to be bad, or at least not to be their fault. Systems are not set up to give patients a voice. The system is set up to silence patients and prevent the community from learning about the experience of patients. That prevents learning. That entrenches problems. And that distorts the world to make it appear to they healthcare professionals themselves that every complaint or lawsuit against them is frivolous.
Some industries protect negligence and abuse by failing to make sense of the data supplied. In addition to doing that, medicine prevents the bulk of the data from being collected in the first place. Adverse events are reported only rarely. Autopsies are done only rarely. Those things are not going to change anytime soon. So the least we need is thoughtful, skeptical people looking at what we already know, not true believers with vested interests making self-serving pronouncements that end with "and I'm a doctor" as though that identified them as having an objective perspective. It identifies them as not having one and we cannot have deep discussions until that is recognized.
It's not just how one acts at a moment.
It's how one responds to the conditions that create such moments.
If you want to understand how a system functions, look at how it handles its worst moments. That makes crime in medicine not only the bellwether of patient safety, but the core issue. The problems that allow crimes to be committed against patients with impunity are the same ones that allow the errors. If we are not solving the crimes committed against patients, we are not working on the causes of errors. But what do we hear from the healthcare industry? We hear about medical malpractice suits. What legislation do they lobby for? Liability limitations. They are more interested in protecting their colleagues than their patients.
Look at the examples of how healthcare providers handle it when healthcare workers commit crimes against patients. They protect the criminals and not only deny the victims treatment, but go on the offensive against the victims to shut them up. In short, they do nothing to protect the next patient or help the current one (if you doubt that, read more about it on this site). That is the opposite of working toward patient safety. And they believe that they are doing a good thing when they do that. They are living in a fictitious world built on a denial of the facts, and they are the ones in charge of patient safety.
When there will be no consequences
some people behave badly.
This will sound dramatic in the same way that the first boy complaining about being abused by a priest sounded dramatic, and for the same reasons, but there are monsters in medicine, predators of every persuasion, and they are protected by every other employee in that profession without question. Automatic, unquestioning silence and protection is the rule (see Loyalty). Careers are ended for violating it. Patients are sued into silence for complaining about it. And people in medicine are as much in denial about that as tobacco company executives were about the safety of tobacco.
Assault, rape and homicide may be more of a problem in medicine than they are in the community in which you live. If you live in a safe suburb, it is possible that healthcare is the most dangerous place you go in terms of the likelihood of becoming a victim of intentional physical harm. Why is no one studying that to see the extent to which it is true? That isn't even on the radar of the medical profession. The medical community lives in a state of denial that prevents it from learning even from examples. Unfortunately, the examples that can be discussed are few because victims are sued if they speak and healthcare workers lose their careers if they speak.
In healthcare, victims of crimes are perceived as crazy patients who need to be stopped. The people who injured that patient, whether intentionally or not, do everything possible to create that perception. Belief in their own goodness is so resolute that healthcare professionals reading this go on the offensive as though this writer were an enemy rather than a window through which they should look.
There is unlikely to be vigilance as long as it is assumed
that they are as virtuous and benevolent as saints
The least a patient should be able to expect in healthcare is to be protected from exploitation, abuse and intentional injury. There are no systems in place that offer that protection. We cannot make fundamental progress on less sinister issues when we do not have systems in place that address these issues. These are the biggest issues in patient safety and they are not part of the discussion.
What we have are systems that silence and defeat the victims of exploitation, abuse and intentional injury. Healthcare as a whole goes as far as to lobby state and federal governments for liability limitations to protect itself from its victims, but not to help their victims. There is no limit on the amount for which healthcare can sue it's victims merely for speaking about what it has done to them, but it has won limitations on how much its victims can sue for after being raped and/or assaulted (that is the practical effect of the liability limitation laws).
The least patients should expect is to be protected from intentional injury
But how do healthcare professionals and the medical community in general respond when they cannot deny a crime has been committed against a patient? Click "Dr. Zoro" to read one of the very few examples that can be discussed, which is why it made the headlines.
May 13, 2000 in Pasadena, California, during a performance of "Prairie Home Companion" Garrison Keillor read a greeting from one audience member to another that said, "Congratulations on becoming a doctor. Now if you can just get over your dislike of people." The audience laughed, but unfortunately resenting or disliking patients is not unusual. It is common for it to begin when they are interns.
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What would cause a person who never had any interest in medicine suddenly one day in a hospital to become a full-time patient and then a patient safety advocate? What would give that person the perspective to see that criminal law is the rock bottom foundation of patient safety? What would cause that person to ask, "Not everyone goes to Catholic Church, but everyone does go to healthcare. Where do you think there is more sex abuse?" What would cause such a person to do a survey to find out if nurses ever report anything? And analyze the disciplinary actions of the state medical board to see what it takes to get them to respond to complaints filed by patients? What would cause someone to notice that all victims of crimes in medicine appear to become the victims of smear campaigns to discredit them? Isn't that part of how miscreants in medicine are able to prey on patients year after year with impunity and sometimes even get rich suing their victims to shut them up? They are amazingly successful at transferring the guilt and blame to their victims.