Conspiracy of Silence Alive and Well

A recent news story about a well-known fertility doctor who surrendered his medical license amidst allegations that he inappropriately touched patients was certainly disturbing. Yet more disturbing was the follow-up story focusing on allegations that nurses and other employees who attempted to report misconduct were encouraged–or directly told–not to voice their concerns about what they’d witnessed.

It’s certainly understandable that nurses and office staff might be reluctant to speak up against a respected and powerful employer.   Our employment laws don’t always protect people who report office misconduct–and even if a fired employee had a valid lawsuit, that doesn’t put food on the table every day.  It doesn’t require much imagination to believe that a physician who would engage in misconduct–sexual or other–would be willing to trump up an excuse to fire an employee who reported the behavior.

But the brief peek into the politics of a medical office afforded by these two articles should raise even greater concerns about reluctance to report quality of care issues and medical errors.  If staff and peers are willing to conceal information about sexual misconduct in order to keep their jobs, it’s a sure bet that they wouldn’t think of reporting even the most egregious medical errors.  Self-interest firmly dictates that the providers will protect themselves at the expense of patients.

This not-particularly-shocking evidence of a code of silence within the medical profession does not bode well for the disclosure and apology movement that hospitals are advocating.  Certainly there are many good reasons–moral, ethical and financial–for providers to own up to medical errors, tell the patient what has happened, and offer fair compensation.  But there are just as many good reasons to believe that’s unlikely to happen on any grand scale.

Most of the examples of disclosure and apology come from situations where the error was obvious; it’s rare to hear of a case where a hospital or medical provider voluntarily disclosed an error that wasn’t likely to come to light anyhow.  The exceptions are for cases where there is little or no resulting injury.  But when it’s a serious injury or a death that the patient or family may not easily realize was caused by a medical error, the code of silence and self-interest usually prevents disclosure.

There are no easy answers for these difficult issues.  But it’s important for patients and their families to recognize that the code of silence thrives in medical settings, and to be appropriately skeptical of what they are told.