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Dr. ZORO and the Dentist

Present in the operating room were the surgeon, the patient, the patient's husband and mother, a resident, two nurses, an anesthesiologist and an assistant.

When the surgeon carved his initials in the patient the resident laughed out loud. The patient's mother cried, "No!" As the surgeon dabbed the wound with gauze the husband finally realized what had been done.

Why Patients Don't Complain

The husband knew his wife and newborn baby would be staying in the hospital for a while. He had just watched a surgeon carve his initials in his wife and no one stopped him or called for help. His wife and child were at the mercy of these people. In order to get them home alive, he decided not to make waves. He also decided not to panic his wife. He did not tell her what had been done to her and did not make a fuss about what had happened.

Why Patients Don't Know When They've Been Injured

Back in her room, the new mother was surprised by the number of hospital personnel coming to her room to look under her sheets. She could not bend in a way that would allow her to see what they were looking at, so she asked. No one would tell her.

That is the way it is in healthcare. Caregivers do not report each other. They do not tell the patient what happened. They do not call the police. They say they would if they ever were in that situation, but when they are they don't. That is what is usual.

What is unusual is that resident laughing. This is something you can be sure that resident will not do again. They learn, or absorb, to behave as though nothing unusual has happened no matter what has happened (see risk management). If you say that to people in medicine, some scoff. But they recognize that the laughter was a mistake and know that that resident should have remained silent no matter what happened - social pressure causing silence.

But these injuries had been signed

If her injuries had been inflicted internally, no one ever would have heard about this. The victim would be sued for defamation if she had said anything and not even the boards or agencies mandated with protecting patients would have believed her.

Since the surgeon initialed his deed and civilian witnesses were present, the victim was able to testify before Congress about the White Wall of Silence in medicine.

Excerpt from Testimony Before Congress is here

The routines that cover up such deeds are just that - routine - routines that  help create an environment in which personnel learn to think they can get away with anything - because they can almost all of the time.

The very first order of business necessary for fixing this state of affairs is creating advocates for the patient community (state patients boards should be one) and allowing patients to speak. Right now they cannot.