So much focus of medical liability system “reformers” these days is about “communication.” Patients would be safer if doctors were more honest about their “mistakes,” the theory goes. Hhmm. I’m not saying that couldn’t happen, but when you’re talking about “communication” in a hospital setting, the concerns of patients don't seem particularly urgent.
Take what’s happening in Wisconsin. There, the medical lobbies are pushing legislation to change state law to lessen what doctors must tell their patients. The standard now is “what a reasonable patient would want to know” but some lawmakers want to change the standard to “what a reasonable physician would tell a patient.”
“The last thing you want to do is roll back the way we get information and how much information we get,” said Martha “Meg” Gaines, director of the Center for Patient Partnerships and an associate dean at the University of Wisconsin Law School.
The proposal would move away from what patients want and need to know, she said, to what doctors think patients need to know.…
Informed consent should be what the patient wants to know - not what a physician thinks the patient should be told, she said.
In a hospital setting, patients are always at an enormous disadvantage when it comes to getting information about their own care let alone protecting themselves from getting hurt. There’s an effort now to burden patients with the responsibility of keeping doctors and nurses from infecting them. Patients are supposed to keep asking health care providers if they’ve washed their hands. That’s because “healthcare workers comply only about half the time…and one in 20 patients will acquire an infection while in the hospital.” So, it should be their job to ask this question, even though it is well-recognized that “speaking up for yourself in that setting is not an easy thing to do"?
“No one wants to be confrontational with the person you hope will save your life,” said Dr. Michael Bell, acting director of the division of healthcare quality promotion at the U.S. Centers for Disease Control and Prevention in Atlanta.
Plus, as one expert noted, “In some ways it says to patients, ‘This is your responsibility for us to do things safely for you, including hand hygiene. Why should it be the job of the patients or family members to make sure everybody cleans their hands? That’s the job of the system.” Ya think?
And not to mention that fact that sometimes, doctors (especially surgeons) can be, well, bullies. USA Today had a story last week about this problem:
Every workplace, like every schoolyard, has its bullies. But when the workplace is a doctor's office, hospital room or surgical suite — when doctors throw charts at nurses or nurses throw insults at trainees — it isn't just a workplace problem. It's a patient-safety issue, these experts say.
"The impact in health care is significant because you are dealing with patients' lives," says Peter Angood, CEO of the American College of Physician Executives in Tampa. Patients who experience or witness boorish behavior have every right to speak up ... because the quality of their medical care may depend upon it.
But who’s gonna do that? For example, should it have been patients' job to question the medical judgment of Dr. Faisal Albania, the St. Louis area neurosurgeon who apparently performed so many risky surgeries on spines, necks and brains, causing “permanent nerve damage, chronic pain and lost income” (and death) that he’s now “a defendant in about 50 lawsuits? Meanwhile, Dr. Albania was allowed to keep practicing “even after the state’s highest court upheld key findings by the Missouri medical board against him.”
“I think he’s hurt a lot of people,” said Alvin Wolff Jr., a lawyer from Clayton who filed a suit last year on behalf of Gary Cotter of Pinckneyville, Ill., that accused Albania of performing an unnecessary surgery on his spine in 2010 that left him in permanent pain and hunched over. “Why do the hospitals let a guy like this on staff? Why do they let a guy like this stay on staff?”
Good question. Where was the hospital here? Where was the state medical board? (Indeed Missouri’s board is sadly typical – check out what’s going on in California.) They clearly weren’t asking the right questions or taking steps to save patients lives. Reminds me of the hospitals featured in last night’s 60 Minutes, which had evidence they’d hired a serial killer nurse, told no one about it, and then gave him a "neutral" reference.