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Originally published December 26, 2012 at 4:30 PM | Page modified December 26, 2012 at 4:29 PM

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Op-ed: The culture of health-care secrecy harms patients

Health-care professionals are silenced by a rigid culture that refuses to admit that medical professionals make mistakes, writes guest columnist Kathleen Bartholomew.

Special to The Times

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THE call was innocent enough. It certainly wasn’t the first time. “My mom has to have a hip replacement. Which doctor would you recommend?”

As a registered nurse, it took but a second to rattle off the names of two stellar surgeons. But as I hung up the phone, I couldn’t help but feel that it just wasn’t fair.

It wasn’t fair that as a nurse I had inside information that the general public could not access. I knew which surgeon had the highest infection rates, and which one had the most complications. I knew the healing power of caring relationships and witnessed significant differences in bedside manner firsthand. I received incident reports when a doctor delayed returning a page in the middle of the night, or when a nurse failed to catch a deteriorating condition.

I knew. We all did. But no one outside the hospital did.

Now, as I educate nurses across the state of Washington, they share their stories: the nurse who accidentally gave 10 times the normal pain medication for her 18-year-old patient who stopped breathing; the physician who operated on the wrong vertebrae — twice; or the patient who called 911 from her hospital bed because of excruciating unrelieved pain after a hysterectomy.

Want to know where bad stuff happens? Which hospital? You can’t. Such knowledge is top secret. Furthermore, you can’t discern the negligent acts from the accidents.

Good, competent humans make mistakes. But health-care professionals are silenced by a rigid culture that refuses to admit that medical professionals make mistakes. We work in an unrealistic culture that blames and shames physicians and nurses who are less than perfect, despite the fact that a perfect doctor or nurse, cannot, by definition, exist. Add this fallacy to a litigious culture, and it’s clear why hospitals are in an extremely tough spot.

Consider that when sued, hospitals and health-care providers almost universally demand a sealed record in any out-of-court settlement of a lawsuit. At all costs, the public must not know. This is a business that routinely pays hush money for accidental death and injury, and gets away with it.

Despite nearly universal effort and education, there has been little improvement in patient safety since the Institute of Medicine’s 1999 report “To Err is Human.” More than 22 patients still die every hour in our hospitals from medical mistakes and unnecessary infections that absolutely could have been prevented. The details of most lethal mistakes will never make headlines.

The result? Those who should not be practicing are protected from discovery, while the vast majority of good doctors and nurses in an archaic system beat themselves up for making human mistakes when they should have been protected by the system from making those mistakes in the first place. (For example, by bar-coding all medication at the bedside and realistic staffing controlled at the front lines by nurses themselves.)

Until the tort system is disconnected from inadvertent medical mistakes, nothing will change because the fear of being sued suppresses the very information we desperately need to keep patients safe.

Twenty-six people dying in Newtown, Conn., in one day is a horror, but the same number of children and adults dying every hour is both intolerable and invisible in a culture designed primarily for self-protection and not patient safety.

What can you do? Demand full transparency from your medical providers, full access to your medical record, full explanation of all pricing and costs and open discussion of true outcomes. The Leapfrog Group’s Hospital Safety Score is a reliable place to start. Go to www.hospitalsafetyscore.org and make it a point to know your local hospital’s grade. You wouldn’t go to an “F”-rated restaurant, so treat your life with the same care you give to ordering a hamburger.

Meanwhile, those of us on the inside will continue to share who we would chose for our loved one.

It’s worse than not fair. It is wrong.

Kathleen Bartholomew lives in Friday Harbor and co-authored the book “Charting the Course: Launching Patient-Centric Healthcare” with her husband, John J. Nance.


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