Excerpted from

From small, local healthcare facilities to hospitals as prestigious as Yale and Cornell, doctors say they have been targeted by hospital administrators or boards if they warn of unsafe conditions or a colleague’s poor work. Even whistleblower laws do not protect them in many cases. Whistleblower laws are supposed to provide legal protection to people trying to report wrongdoing, but they are not adequate to protect whistleblowers in medicine.

Over a period of 10 months, the Pittsburgh Post-Gazette examined cases across the United States in which physicians who spoke up about poor care faced reprisals, including peer review hearings, demotions, temporary loss of credentials, involuntary transfers or outright dismissal. In a case in Missouri a physician was cited for violating patient confidentiality after he tried to get the possibility of serial murders investigated at the hospital.

According the the Post-Gazette, a 1998 survey of 448 emergency physicians across the United States found that 23 percent had either lost a job, or were threatened with it, after they’d raised quality-of-care concerns.

Those who have witnessed reprisals against physicians or were targets themselves are troubled that advocating for better patient care can be seen as disruptive and lead to serious professional consequences. Some say it’s like arresting a person who yells “A man’s been shot!” for violating a noise ordinance.

“We’re the only people who can stand up for patients,” said Dr. Scott Plantz, an emergency medicine specialist who headed the survey of emergency physicians. “The nurses can’t, because they’re employees of the hospital. But doctors aren’t, or at least they weren’t in the past. With managed care, and doctors working for hospitals, it gets worse and worse and worse.”

“There’s an attitude that it’s better to cover [a problem] up than to let it be known and correct it, because [a hospital] cannot afford the consequences of letting anybody find out that it went wrong,” said Dr. Edward Dench, who just completed his year at the reins of the medical society. Dench said he became a target at Centre Community Hospital after questioning procedures there.

“If a nurse or physician speaks up and says, ‘This is wrong,’ they are the ones most likely to be punished.”

And that’s only counting the ones who have the courage and conviction to speak up. Many others weigh the professional and financial cost and do not come forward, thus silencing the patient’s most knowledgeable advocate.

Whistle blowing physicians can find that disagreeing with hospital administrators is career-ending. Once they’ve been labeled disruptive, doctors may effectively be banished from the profession. This is hospitals silencing doctors by using federal legislation that was intended to protect patients.

An even more ironic note is that the silence turns out to be bad for doctors too. Confidentiality laws passed to protect the patient’s and the doctor’s privacy make it so that physicians who are wrongly or maliciously accused can be pulled into hearings where they have no legal representation and no opportunity to face their accusers.

Peer review is not apolitical. The people administering and working in healthcare are not saints. We need systems that recognize that. We should start with systems that listen to patients and enforce the law.

For Instance

At a meeting of Organized Medical Staff Section (OMSS), a branch of AMA, Dr. Danae Powers told a group of physicians how she was targeted after she pointed out problems at the hospital where she was an anesthesiologist. She had been looking into reports from both nurses and physicians who said that a senior anesthesiologist was falling asleep during surgeries. She also questioned whether patients were getting adequate pre-operative examinations and whether bad outcomes — including patient deaths — were being properly investigated. In response, she said the hospital launched an investigation of her and “made my life miserable.” She was treated as though she was the problem, as though she was a disruptive physician.

Dr. Brian Johnston, an emergency medicine physician in Los Angeles and secretary to the OMSS Governing Council, said “a great number” of AMA members had expressed similar concerns about being targeted.

Her talk was titled, “Disruptive or Determined to Do What’s Right? The Case for Courage Under Fire.”

It’s not just management who silences, and not just physicians who get silenced.

Nurses silence other nurses.