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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