By Evan Falchuk
There is a disturbing story in the Hartford Courant (via the WSJ Health Blog) on how Connecticut state lawmakers have helped hospitals keep medical mistakes secret from the public. It’s true:
The legislature in 2002 ordered hospitals to disclose all serious patient injuries “associated with medical management.” But after the first reports were made public, hospital lobbyists persuaded lawmakers to rewrite the statute in 2004, limiting the kinds of adverse events that must be divulged, and promising to keep reports secret unless they led to an investigation.
What happened next is predictable. According to the Courant, public access to data about hospital adverse events dropped by 90%.
Is this a good thing?
The state and hospitals seem to think so. They say that the more limited reporting requirements mean that reporting is targeted at serious problems. A spokesperson for a major Connecticut hospital agreed, saying that “questionable cases” are reviewed by senior management, and forwarded to the state if they meet the criteria for reporting. They also say that keeping the reports secret makes the hospitals more willing to report honestly on adverse events.
I don’t doubt the integrity of the people involved in these programs at the state or hospitals. But the system they have set up can be summed up as “trust me.” Trust me that I will know, as a hospital, when an event is serious enough to report to the state. Trust me as the state that I can figure out what’s important to tell the public what is and what isn’t important. Trust us that the quality of hospital care will be better if we can just keep you from knowing too much what happens when people are treated in them.
I appreciate that people like to manage bad news in private. In an organization, it can be an understandable instinct of self-preservation. But more broadly, hiding mistakes is a very bad thing.
Why?
First, it gives the impression that the hospitals, and the state, actually have something to hide. I mean, otherwise, why hide it? Maybe they are worried the public will misinterpret the data. But then why not spend a little bit of time educating people on the meaning of the data? That seems more productive than simply hiding it. And don’t the hospitals and legislators see that by hiding it in this way all they are doing is magnifying the importance of whatever it is they are hiding?
It also corrodes the trust people place in what ought to be trustworthy institutions. The data ought to just be the data. The state and hospitals should ensure the data is accurate, understandable, and consistent. By focusing on figuring out what is appropriate for the public to see or not the data becomes unavoidably tainted with politics. Worse, it creates a perception that certain public servants have special access to information, which the rest of us are not worthy to see. That’s not how America’s supposed to work, and one reason Justice Brandeis’ wisdom that “sunlight is the best disinfectant” is so timeless.
Finally, keeping these kinds of things secret robs all of us of the opportunity to learn from mistakes. Teaching hospitals and others commonly perform what are known as “morbidity and mortality” rounds. These are conferences in which doctors meet to discuss mistakes, bad outcomes, complications and the like. The purpose of these rounds isn’t to lay blame, but rather to try to figure out what went wrong, and how to learn from the mistakes.
Broader studies on misdiagnoses show that if you collect lots of data on what goes wrong you can discover interesting things that can improve the quality of care. For example, some researchers are categorizing how and why medical errors happen, helping avoid these kinds of mistakes in the future. But without data, you can’t do these good and valuable things.
So, yes, I understand the instinct to keep bad news secret. But our philosophy ought to be openness and transparency. Not only because it helps improve the quality of care but because it’s simply the right thing to do.
