White Wall of Silence
Denial Isn't Always Conscious
As early as the 1950's, the psychologist Solomon Asch did a series of laboratory experiments in which he put groups of people in rooms and asked them simple questions that any child could answer correctly, such as which of three lines drawn on a piece of paper was the longest. The answer is obvious, unless other people answer it incorrectly first. All of the people in the room were plants except one. The plants would agree on an incorrect answer. After witnessing that agreement, other people usually agreed with it too. Things that obviously could be seen to be wrong by an independent observer, were not seen to be wrong because of the suggestion of others.
Three out of four people gave an incorrect answer to a simple question after overhearing others give that incorrect answer. Recent research (lead by Dr. Gregory Berns, a psychiatrist and neuroscientist at Emory University in Atlanta) using MRI's shows that they are not lying. They actually see solid, physical things differently based on what others have said. They do not believe their own eyes as much as they believe what the group says.
Seeing is believing what the group believes
These studies were done with groups of strangers with little in common. Imagine how much more influence the false answers would have had if uttered by members of the same profession, for instance if all the subjects had been police officers. Imagine how much more influential than that it could have been if all the subjects were not just members of the same profession, but knew each other and worked with each other everyday, like members of a surgical team. This is beyond merely learning not to report Hodads, learning not to criticize other health care professionals in the record, and similar conscious refusals to make honest records. This is not believing the evidence of their senses.
Could there be a less sinister explanation for how Charles Cullen, Micheal Swango, James Burt and many similar examples were protected by all other healthcare workers, by the hospitals in which they worked, and even by their state medical boards? (We'll get to more sinister explanations later).
2% rate of accurate reporting
According to the United States Department of Health and Human Services, and others, when things go wrong in medicine they are not reported anywhere at any level 93% of the time. When they are reported they are reported inaccurately 2/3 of the time. Which means that they report negative information accurately 2% of the time.
Try to find anyone in medicine who believes that. How are they going to protect you from the problems, how are they going to fix them, when they don't even see them?
What they see is that everything is fine when it is not.
Self Confidence is Contagious
Dr. E. James Potchen at Michigan State University in East Lansing studied the accuracy with which certified radiologists studied x-rays. One of the things he found was that even those who were the worst at it were highly confident in the accuracy of their work. That's how health care professionals see the world.
Asking health care professionals to make medicine more transparent is ignorant. Not only don't they see it when their colleagues are the problems. They especially don't see it when they themselves are the problem. So how would they recognize the wall they have built between patients and the information patients must have to make safe choices? They don't see it.
The Great Sidewalk of Medicine
Something I hear repeatedly from people in medicine is that the rest of the world could not "understand" the tough calls, the gray areas, the complexity of medical knowledge. As though a patient would need a medical degree to know if she were being raped. And would be incapable of recognizing when no one reported it. And would have no way of knowing when no one would diagnose the injuries because they were iatrogenic.
When a self-interested behavior is the norm accepted by all of your colleagues, perspective has little chance. Walls appear to be merely the sidewalks you walk on, not the walls you have created for someone else.
And they don't know that about themselves.
Community Patient Agencies
That's why mechanisms, like Community Patient Agencies, need to be established to gather information from patients without the interference of the health care community. Otherwise we never will learn their success rates and failure rates. It is not possible to give informed consent without that. It is not possible to make safe choices without that. Health care professionals never have had, and never will have, the objectivity to collect the information necessary to make safe decisions for patients. We should stop complaining when they don't. We should recognize that they aren't saints and erect solutions that enable patients to protect themselves.More about Silence->