Doctors need to become whistleblowers after medical error

Perhaps the most important principle in practicing medicine, drummed into medical students and junior doctors time and time again, is to do no harm.  Our medical interventions and treatments can be given either too early, too late, or inappropriately, with sometimes terrible and tragic results.

Unfortunately, when doctors have harmed patients, the guidelines of what to do thereafter are not as clear, raising the question, “What should doctors do in these situations?”

This has to be the hardest question we have to face — more difficult than even than when deciding not to treat, turning off life support, or choosing which twin of a conjoined pair needs to die to save the other.  Most doctors would have second thoughts and distress about having to make any of these decisions.  But these difficulties pale in comparison to “blowing the whistle” on a colleague or an institution.

Why is whistleblowing so much harder?  Because the whistleblower is deeply involved, and likely to remain so for months, if not years, with financial and career threatening consequences.  To fulfill our ethical responsibilities, we must make life very unpleasant for ourselves.

KevinMD.com, for instance, has two stories on the topic, The story behind a whistleblower doctor license reinstatement hearing and Whistleblowers endure stress and personal hardship.

I have seen families not only suffer the death of a member, but also pushed into financial ruin, because the medical treatment has clearly been very poor.  No one has acted to correct the doctors responsible, or to suggest to the families that their financial needs could be met by seeking legal recourse.  The consequences of these tragedies are considerable, playing out over generations.

Sometimes, I cannot help feeling that I am a spectator to a silent crime, like an accomplice or a reluctant witness.

And that is the major problem with a system that lacks peer review and support mechanisms, cannot acknowledge that we are all human, or allows for the fact that mistakes always will be made.  We are expected to be accomplices by default, bound by a tradition that doctors must stick together and not break rank.

When the error is mine, the best I can do is to apologize to the patient or family, acknowledge that an error was made, and face the consequences in an open and transparent manner. When witness to a colleague’s error, or an institutional cover-up, things get very difficult.  Ethical teaching suggests stepping forward would be the right thing to do.  Common sense suggests otherwise.  I do not expect my colleagues to do as individuals what I have great difficulty in doing myself.  The only viable alternative is when an entire medical community agrees to peer review and turns whistleblower.

But long as common sense continues to trump ethical behavior, doctors and patients alike will suffer.

Martin Young is an otolaryngologist and founder and CEO of ConsentCare.

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  • http://www.twitter.com/alicearobertson Alice

    This article is better than medicine to someone who has experienced a medical error, then a peer review that felt like a medical type of slap down.. The emotional toll and longing for acknowledgement and an apology is almost beyond words when your world is spinning out-of-control. In legal realms it is said a patient never sues a doctor they love and the type of heart nedicine you prescribe can heal a broken heart…which can often help more than surgery or pills.

  • Marc Gorayeb, MD

    Not sure what you are getting at here. What is it that you want to blow the whistle on? Intentional malfeasance, willful ignorance, gross negligence, simple negligence, poor judgment, or adequate judgment combined with poor outcome?
    Do you want to blow the whistle on cases where patients are badly harmed, reversibly harmed, almost harmed, inconvenienced, or not harmed at all?
    Should it be limited to physicians who are repeatedly culpable, or is a single mistake sufficient? If more than one mistake is required, then how many should trigger the whistle?
    What about mistakes or errors in which cause and effect are not so clear?
    Who should make these judgments? You? Me?

    In fact, every hospital is required to have departmental and hospital-wide peer review, theoretically protected from legal discovery. The issues relating to clinical competence can be very complex, requiring objective review and analysis by a number of physicians. Medical staff bylaws and rules govern how these reviews are to be handled.
    If you are concerned about failures in these procedures, consider whether there is a lack of confidence in the confidentiality of the reviews, whether the reviewers have a conflict of interest, whether the hospital administration interferes with the process, or whether individual physicians have been allowed to amass undue financial influence over the hospital’s operations or the practices of other physicians.
    There are systemic reasons for any failure of peer review. Without a thorough analysis of individual cases, it is inappropriate to generalize about how “common sense continues to trump ethical behavior.”

    • http://www.consentcare.com Martin Young

      My preferred title was “The hardest ethical decision that doctors ever have to make.” The heading here was an editorial decision.

      My point is that the system does not cater for the ethical expectations made of us. Many doctors like me do not work under peer review, and there are few networks established to make this possible.

      There are expectations made of us that are very, very difficult to keep because to do so carries a huge personal cost.

      The system is faulty.

      • http://www.twitter.com/alicearobertson Alice

        There are expectations made of us that are very, very difficult to keep because to do so
        carries a huge personal cost. [end quote]

        That is the sad summation, and yet from a patient’s viewpoint it is costly when doctors cover for each other.

  • Lady Patient

    From a doctors POV the many reasons for reluctance to turn in an impaired or addicted co-worker is understandable.

    But from the patients POV, turning a blind eye to a medical worker who is in the process of doing me harm, or has the potential to do so, invalidates any argument for tort reform.

  • http://www.talktoyourunconscious.wordpress.com BobBapaso

    As long as you can get sued for an unlimited amount for making them, errors will be hidden. When we have a system that fairly and promptly compensates their victims, without requiring them to sue, then they will be freely admitted and their causes corrected.

  • elaine

    Contrary to what many would like us to think, it is difficult to sue in malpractice cases. In product liability case (hot coffee, asbestos). it is easy relatively speaking. Malpractice litigation needs reform so that the punishment fits the crime. If I murder someone, it does not matter if the person is 30 or 70. But if I commit malpractice, it is an undeniable fact that if you are old, your case in many situations has no economic value because you are already a drain on society and have no eccconomic impact. Take the case of my mother, an active 75 yr old at the time of her diagnose with cancer. She weathered her chemo fairl;y well, but developed progressive and unrelenting back pain requiring heavy doese of pain meds and even injectable Morphine. An MRI was misinterpeted and the diagnosis of osteomyelitis was missed. By the time a new MRI was performed, her spine was unstable because the disease had markedly progressed from the earlier MRI. I was told by both the neurosurgeon and the interventional radiologist that the diagnosis was clear on the first MRI. But I could find no one to take her case, because at her age and with the diagnosis of cancer, her lawsuit was worthless!