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Patient SafetyMedical mistakes and frivolous suitsPeer review and informal sanctions are inadequate substitutes for public surveillance and accountability. Legal scholar and physician, William M. Sage, makes the case for that in the book Accountability. In that same book, Ethicist Nancy Berlinger says that even the systems in medicine that promote "confession, repentance, and forgiveness" are limited to the professional side of medicine and do not ensure justice for patients. There are those who think that the most important thing that can happen for patients is for information about errors, sins and other dangers in medicine to be recorded and revealed so that the community can understand its health care and bring pressure on medicine to respond. But nearly all the people working on patient safety initiatives have a different idea. They believe in a model that continues to keep patients as helpless pawns. Instead of fixing that they focus on how to promote a supportive, non-punitive environment in which health care professionals for the first time in history voluntarily will report adverse events. It is as though they imagine that tweaking the environment in medicine will eliminate ego, embarrassment, peer ostracism, loss of reputation, and concerns about lawsuits and license revocation and damaged careers. It is as though they believe that there are no sociopaths with licenses to practice medicine. Patient abuse will never be reported by the abusers. Peers cannot review what never is reported. Patient safety initiatives that do not acknowledge and address the darkest side of medicine will not overcome the obstacles to reporting even the most simple, well-meaning errors. This site is about why and what can be done about it. Hundreds of thousands of patients per year will continue to die unnecessarily until this is fixed. How can we imagine that we can put in place systems that will reduce cost and increase quality when we do not even have in place systems that address incompetence, exploitation, abuse, and murder? They aren't just part of the same package. Justice is the foundation for it all, particularly criminal justice. Even if it weren't - caregivers prey on helpless patients. People who do that do not voluntarily report it. The fact that it isn't even part of the discussion should be all we need to know about how much to trust the government and/or the medical industry with our well being. The discussion should not be about who to put in charge - government or big medicine. The discussion needs to be about how to make it so that as a community patients can protect themselves. In two hundred years doctors and politicians have not been trustworthy caretakers of our well being (see Benjamin Rush). It's time woke up, stop believing in the benevolent dictator model and arrange things so that patients will be safe even when physicians do not put the well-being of their patients ahead of their own.
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