We’re Having a Meeting About You…

secrecyNo, you can’t come.  And no, we’ll never tell you what we say.  If we figure out why you or a family member suffered a catastrophic injury or even died, it will remain our little secret.  Ours, not yours, And there’s nothing you or anyone else can do to make us tell you.

That’s peer review.

Peer review is a process in which every hospital in the country engages when there is a bad or unexpected outcome.  The doctors involved in the patient’s care get together in a meeting, often joined by other doctors from the same medical or surgical department.  They review medical records, oral or written statements from the health care providers involved, and other sources of information available in the hospital.  Sometimes, they even get reports from outside consultants.  They discuss what happened, whether it could have been avoided, and how to prevent similar occurrences in the future.

Sounds like a great idea, doesn’t it?

Unfortunately, the people with the greatest interest in the outcome–the patient and his family–will never find out what happened in that meeting, or what conclusions were reached.  Never.  Not under any circumstances.  No way.  In fact, some hospitals have even fought to keep that information away from the Board of Registration in Medicine, the state agency that is charged with protecting the public by disciplining bad doctors.

The original rationale for peer review statutes was that doctors needed to be free to criticize other doctors in order to improve the quality of medical care, and that they would not speak freely if they knew that their comments might become known to others.  Translation: we’d much rather lie to patients than criticize another doctor in public.  (Does anyone see a problem with this?)  What they really mean is that they don’t want some patient’s lawyer coming along and figuring out what went wrong.  But what’s lost in the dust-up between the doctors and the lawyers is… the patient.

It’s bad enough that no other profession or industry or governmental body gets to hide behind the veil of secrecy that has been created for doctors in virtually every state in the country.  Imagine, if you will, if a product manufacturer who had received complaints of injuries and death from consumers, came out and said, “We had an internal meeting.  We figured out what went wrong, why people got sick and died.  But we’re not going to tell anyone what we found.”  That’s bad enough.  But to add insult to injury, so to speak, the rationale is that doctors won’t tell the truth if someone might find out what they said.

Late last year, Massachusetts enacted a “Disclosure and Apology” statute, which  is supposed to encourage health  care providers to tell patients when a mistake has been made.  It’s a great idea, but as long as doctors know that the truth can never be forced out of them, I think it’s unlikely to do much to dispel the culture of secrecy that surrounds the medical profession.