Path"< Truth / Justice / Patient Safety >" is a pathPaths lead from one place to another. In computers they are expressed by a succession of landmarks separated by slashes. <SanFrancisco/Denver/St.Louis/NewYork> would get a Californian to the other coast. Routing determines destinations. We must start with Truth. Otherwise we cannot see the obstacles. If we do not proceed to Justice, we have not overcome them. Patient Safety cannot be reached on the current path, which probably best can be expressed as /TrustUs/. It is not exclusively about trust. However, at the very least, our systems must be able to address issues of trust. If our feedback structures are such that they cannot throttle even unfriendly practices, of what use can they be with regard to subtler issues? At the bare minimum, we must be able to arrive at truth and proceed to justice. The Institute of Medicine defines patient safety as freedom from accidental injury. The Agency for Healthcare Research & Quality, in its Five Steps to Safer Health Care, mentions only steps that help with a competent, interested and honest healthcare provider - nothing about what to do when they worry that your case could harm the career of the healthcare provider who ruined your life. In these there is no nod toward issues of trust - the most fundamental problem for patient safety. Without addressing issues of trust, we are never going to get to even the more modest goal of solving accidental injuries. A means for patients to respond to injuries must be put in place, partly because physicians and nurses do not advertise their mistakes. They cover them up with dire consequences for the effected patients. Injured patients too often cannot even get diagnosed, let alone treated, because of how unified medical practitioners are in protecting each other. No one wants to create a record that indicts other healthcare professionals. The only recourse patients have had in the past was to travel far enough to find healthcare professionals who did not have access to the network that branded them as people who could sue or indict a fellow practitioner. The ability to escape a prejudiced network may be lost with the new electronic health information system being proposed. It could enable iatrogenic injuries to be covered up nationwide more easily than they currently can. Part of what might be necessary is for patients to be given control over their records, like the ability to expunge or seal portions, or possibly all, of them. But the definition of patient safety and the list of steps to safer healthcare need to include reference to issues of trust. The medical community turns up its nose and does an about-face whenever this is mentioned, but if patient safety initiatives do not address crime they are shallow. The least patients should expect is to be safe from violence and sex abuse and the other abuses in which humans indulge when they believe they can get away with them. From the outside it looks as though these crimes would be hard to cover up because there are multiple sources for the information about those crimes. It appears that one person could not write a patient's history in a self-protecting way. But patients who have been on the wrong end have watched how completely one healthcare professional can prevent an accurate history from being recorded, and can prevent the patient from being able to get the injuries diagnosed or treated. Unfortunately, I cannot tell you about the cases that brought me here. I have included a paper trail showing the blacklisting of a patient by a doctor to cover a case up. However, I am not allowed to reveal enough about it for anyone to arrive at truth and proceed to justice. Under these circumstances, there is little worth salvaging from current feedback structures. A new architecture has to be erected (see citizen oversight for one possibility). Initially it will have to be outside the institutions currently charged with truth, justice and patient safety as they will not do it no matter how clear cut the injustice or crime. They will not address issues of trust. They brush off statistics and examples as being unimportant or unbelievable. It is a self-serving, self-deception. What are the obstacles?The people who know the obstacles best, injured patients, are sued if they speak (see freedom of speech for patients). The culture of silence (see silence versus safety and risk management) prevents the worst problems from being reported by healthcare professionals. And they are the only ones creating the records. There is no other source for the most necessary information to form a clear picture. There is little appreciation for the extent to which the data is corrupt. The patient safety movement is working very hard on difficult and complex issues that, in the end, are shallow and don't consider the issue that must be considered the bellwether for all of patient safety - crime in medicine. As long as we do not have structures capable of uncovering that, we don't have structures sufficient for learning about the worst accidents either. They rarely will be reported and the patients who are victims rarely will be discovered. Patients continue to die unnecessarily year after year and will continue to until this changes. Medicine will continue to be a virtually lawless place where witnesses will not report rape and homicide, victims are sued into silence and offenders operate with impunity. The extent to which this is true is something to which the patient safety movement is self-servingly oblivious. The stories that make it understandable are not allowed to be told. I have been forced to remove them from this site. And numbers, like the amount of assault, rape and homicide in medicine, are brushed off as though they are not the most fundamental problem for patient safety. Patient safety is a path. We must start with knowing what's true. That is what mandatory reporting laws were passed to address with no effect. That, perhaps, is the first issue of trust that should be addressed. The information gathering system must expand so that a unified collective of self-interested people who are loyal to each other is not the only source. Currently, sufferers of iatrogenic injuries cannot even get their stories in the record, whether the injuries were inflicted accidentally or not. And those injured patients are not merely left behind but are crushed and defeated by dishonest operators in a system that has no checks or balences. |
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