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Secrecy is not consistent with accountability

The resistance of medicine to investigate and understand the problems is in itself a major problem. Medicine is not hungry for information about patient safety problems. It is hungry for liability limitations and amnesia. It stopped doing autopsies. It discourages nurses from keeping diaries of daily activities because those can be subpoenaed. It teaches operating room personnel never to ask the patient if he/she is all right after something goes wrong, because that is evidence that something went wrong.

They don't want anyone to know when something goes wrong. And if they happen to discuss later what went wrong, the discussion will not be with objective investigators. The discussion will be with loyal colleagues. Mortality and morbidity conferences cover only what health care professionals are willing to admit and only with people who share their perspective in fundamental ways.

Say that to someone in medicine and they point out all the differences in perspective among their colleagues, but they are viewing the world through a narrow lens. Part of why patient safety is not improving in any substantial way is the narrowness of the lens that health care professionals believe shows them the whole world. They are too myopic to be humble enough to acknowledge that and that is part of the problem.


Agnotology is an odd word that may or may not gain wider acceptance over time, but currently some use it to describe the study of ignorance, especially protective ignorance. It often is safer not to find out. Institutions and the individuals in them often desire not to learn too much and not to see too much. They don't want certain information recorded and they don't want to know what was not recorded. They don't want to see what the world looks like from other perspectives. They want to protect themselves and their view of the world.

How can we proceed?

They don't believe that murder in medicine is more of a problem than, say, "frivolous" lawsuits. They don't see criminal law as being the rock bottom foundation of patient safety. If they did, wouldn't they be working on the murder rate in the same way that they work on other causes of mortality? If they did, would they be lobbying to further insulate from consequences even colleagues who exploit and rape and murder patients instead of brushing off such issues as being insulting to their profession?

Wouldn't they approach working on the murder rate in health care in the same way they approach coronary disease if it was their perspective that murdering patients was as unacceptable to them as "frivolous" lawsuits? Three parallel phenomena have been attributed to causing the 50 percent reduction in coronary heart disease mortality over the past 40 years: an understanding of the risk factors, an indisputable evidence base on which to make decisions, and the flexibility to change systems in response to new knowledge. To what extent would the medical profession accept the same phenomena being applied to reducing murder and other crimes in medicine?

Currently it is unacceptable for doctors to record the complaints that patients make about other doctors. That's not just a matter of practice. That is written policy. No one in medicine believes such complaints anyway. Some in medicine say that the first rule of medicine is that patients always lie. From whence will come the evidence on which to make decisions when no one listens to the only people reporting it? Patients are the only ones who report crimes committed in medicine. How can we reduce mortality when the profession enforces silence about its causes? How can we proceed in the face of system-wide denial not only of the risk factors but of the fact that there is a problem at all? How can things improve when suggesting to someone in medicine that some other member of their profession is bad/dangerous/evil is received as a cop would receive it if someone aimed a gun at another cop? How can the murder rate be reduced if there is nothing but resistance to going after the murderers?

Under Construction

There is a Congressional mandate to aggregate statistical reporting to monitor quality and patient safety trends over time. That is recognition of the need, but it still is being treated as though passing a law could get health care workers to report, and as though someone other than patients could make the best use of the information.