/ Trust Us /
The system is set up to protect healthcare workers
even when
they prove untrustworthy
Dr. Barry J. Marshall, who shared the Nobel Prize for Physiology or Medicine, said that if he had come through normal training he would have been so indoctrinated that he wouldn't have been considering the possibilities that led to the discovery he made. There is little recognition of the extent to which people in medicine are indoctrinated. In terms of patient safety, they themselves do not know what the problems are (see risk management), how bad the problems are and how many are hurt by the problems. Too frequently they don't even know when they themselves are the problem (see mammography).
This is part of why they cannot be trusted. Part of the indoctrination in medicine is blind faith in their own goodness and the goodness of their colleagues and their profession as a whole.
Far fewer people die or are injured each year in traffic accidents than die or are injured unnecessarily* in healthcare. When you consider how many more times people enter cars than healthcare, that is not good. Add the crime rate in medicine to that and it looks even worse. Yet our caregivers will not report it. They will not even record the claims made by patients who suffer from it.
The number of prescription errors made in hospitals is equal to the number of patients admitted each year. No one in those hospitals reports the vast majority of them. And doctors won't make a record of it when patients complain about them. The same is true of crimes reported in medicine. Victims of crimes committed in medicine can find no one who will record in the charts the source of the injuries. Often they cannot even get adequate treatment because no one wants to diagnose the injuries. Caregivers do not believe other caregivers do these things. There are more reasons for that than indoctrination (see silence), but add indoctrination to the list.
Refusing to keep track
is refusing to learn from experience
If murder and rape are rare in the general population, should we ignore them there as well?
The problem is not only whether patients can trust healthcare providers, and not only whether providers can trust each other (see blacklisting), but also whether they can be trusted to be honest with themselves (see Burt & Schramm) in an environment that protects, and sometimes even requires, dishonesty. Loyalty is the core operating ethic of medicine, not integrity, and not safety. When things go wrong, disloyalty is what ends careers. Failing or refusing to report problems does not end careers. Failing or refusing to help patients does not end careers. Being disloyal to colleagues does. And loyalty equals silence.
Where there is such silence
patients are not safe even from unfriendly practices
Saying "healthcare professionals protect each other, not patients" will sound harsh to healthcare professionals, but overly gentle to injured patients and their families. The fact that in medicine there is no acknowledgment of this, only denial and cover up, is why no one in medicine ever will fix it. The culture in medicine is overwhelmed with a refusal to acknowledge the reality of the damage caused. Oversight will have to be put in the hands of patients. Experience shows that patients cannot trust medical interests to do it. Peer review does not cull monsters from the profession. Witness how violent offenders, like Michael Swango, are shuffled around rather than indicted. Medical interests share the same indoctrination, the same self-serving world view. When determining the conditions in prisons, if you speak only to the guards you have missed the most important voice.
On important points, people in medicine are living in a fictitious world built on a refusal to acknowledge the facts. And at present, they are our only source of information about it.
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*Unnecessarily means checking in with a sprained wrist and leaving in a hearse, not failing to be cured of cancer.