The Medical Conspiracy of Silence

February 25, 2012
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One of the most common complaints patients have about their doctors is that they will refuse to criticize a colleague even when they know that he has been grossly negligent in his actions.
Whenever a complication occurs in the course of medical treatment, one of the worries every patient has is – Was this complication preventable ? Could it have been avoided ? Or did it occur because my doctor was careless and didn’t do a good job ?

One of the most common complaints patients have about their doctors is that they will refuse to criticize a colleague even when they know that he has been grossly negligent in his actions.
Whenever a complication occurs in the course of medical treatment, one of the worries every patient has is – Was this complication preventable ? Could it have been avoided ? Or did it occur because my doctor was careless and didn’t do a good job ?

These are difficult questions to answer, because the body heals unpredictably and every illness has its own natural history and runs a different course , which varies from patient to patient. This is why patients will often ask for a second opinion when things are not going well ; and they expect and want and need a truthful answer from the doctor. However, they find that even though they have a very high index of suspicion that their doctor was negligent or careless, it’s very difficult to find another doctor who will agree to criticize another doctor’s actions.
When they encounter this barrier , patients are naturally led to believe that the medical profession engages in a conspiracy of silence against patients. They find this very frustrating., and this adds to their anger.

When things go wrong , patients deserve an honest and truthful answer. If the complication has arisen as a result of medical negligence , in all fairness the treating doctor should be willing to share this information with patients and say sorry. However , the reality is that patients are likely to be vengeful and angry , and because doctors are understandably scared and want to protect themselves , they will refuse to be frank and forthright. However, patients are smart and they can smell that something is amiss. But since they do not have the expertise to be able to figure out what went wrong and why and when , they need another doctor to provide them with assistance.

Unfortunately , doctors out of a misplaced sense of camaraderie and the misplaced belief that they need to protect each other , will often refuse to criticize another doctor. This reluctance is understandable. After all , doctors are often friends. They refer patients to each other and have common interests. They’d much rather close ranks and stand up for each other, rather than be critical. Also, doctors know that medicine is unpredictable; and that it’s very easy to be wise after the event ! They also know that it could be their turn to be on the firing line the next time , and if that they are willing to protect their colleagues now, that their colleagues will be much more likely to protect them , in case something goes wrong with one of their patients. Also, because doctors belong to the medical community , they don’t want to be ostracized by being treated as a whistleblower or a critic of the medical profession , so they’d rather keep quiet, rather than stand up and voice their opinion publicly.

Some doctors refuse to criticize others because they feel that it is unethical on the part of one professional to badmouth and other. While it’s true that not every complication arises as a result of the doctor’s negligence, I don’t think it’s fair on patients if doctors clam up and refuse criticize other doctors just because they want to protect each other. This kind of silence only serves to protect the guilty and actually ends up making a bad situation worse because patients start losing faith and confidence in the entire medical profession.

While I’m not suggesting that doctors should start bad mouthing each other, I feel an intelligent doctor can take a balanced approach and share information factually with the patient , emphasizing the fact that even when things go wrong, this is not because the doctor intended the patient any harm . The truth is that the human body is a complex system and it’s not always possible to predict how it will respond, no matter how good the doctor’s intentions.

If patients can be confident that doctors will tell them the truth, they are much less likely to be suspicious and adversarial. It’s only when they feel that doctors are trying to protect each other that they are forced to go to court in order to seek redressal. While we cannot prevent errors from happening, at least being honest with patients about these errors can help to prevent them from happening in the future. Even more importantly, all of us are aware that there are some bad apples within the medical profession and by keeping quiet , we are actually encouraging them to continue with their bad behavior. If we refuse to police ourselves, then judges and lawyers will do this for us – and this is not a very happy situation. Doctors need to step up and take responsibility for the fact that they are a profession ; and that all of us are responsible for making sure that other medical professionals act in the manner in which they supposed to.