'Don't tell' culture a plague on health care

Dr. Kevin Kavanagh of Somerset is chairman of Health Watch USA.
Dr. Kevin Kavanagh of Somerset is chairman of Health Watch USA.

One of my most haunting memories in medicine — one that I have lived with for more two decades — involved choosing to betray a doctor, a colleague and my closest friend, and to do what was right for a patient.

I was on call one weekend when a young beautiful girl in her early 30s was admitted with a severe infection in the sinus beneath her cheek. It had spread to the overlying skin causing it to harden and permanently indent. We rushed her to the operating room and performed lifesaving drainage, but in the process we removed an old smelly gauze pack left in the sinus from a previous surgery performed by my colleague.

Another doctor was supposed to have removed the pack a few days after the first surgery, but he forgot. My assistant asked me what he should tell the patient. I answered, "The truth."

For that, I was summarily called into the office of a retired, well-respected senior surgeon who sat me down and instructed me on how I should have quickly removed the pack by placing it in a gauze so no one would see it and then thrown it in the trash.

I said, "I'm sorry," and left the room. Luckily, I was never placed in a similar situation again.

Years have passed, and things are starting to change in medicine. Telling patients that something went wrong is slowly being accepted — a revolutionary idea to medicine, but one that leaves the general public in bewilderment.

Could you imagine your child falling and breaking his leg on the school playground and then being told that it did not happen here so we are not responsible, it happened on his way to school? That would horrify a parent, but in medicine, there is a culture of not telling in most, but not all, institutions.

Unfortunately, I have heard similar excuses for the occurrence of health-care acquired infections.

But the most devastating effect of the lack of full disclosure is on the overall quality of the institution. The Leapfrog Group reported in October 2011 that hospitals that followed a policy of full disclosure had lower patient death rates than those that did not. This may on the surface appear earth-shattering, but it is really just common sense.

If preventable patient harm occurs on a ward and the patient is not told, almost all of the employees on the ward will know about the coverup. How then will the administration garner the respect to effectively oversee the functioning of personnel? If hospital staff are not performing adequately, how do you discharge them when there are skeletons in the closet?

To put it another way, if I performed fraudulent billing in my office and my secretary then steals $10,000 from me, my options for recourse would be severely limited.

One of the surprising findings of full disclosure is that besides being the moral thing to do, it also lowers the institution's malpractice expenses. Stanford University Hospitals recently observed a 36 percent drop in malpractice claims and saved $3.2 million since adopting a policy of full disclosure in 2007.

This mirrored the experience at the University of Michigan, which saw a 40 percent drop in new claims at a savings of $2 million a year. And at the University of Illinois' institution of a full disclosure policy saw the number of lawsuits drop 30 percent.

In Kentucky, we are not just behind, we have dropped the ball.

In 1987, the Veterans Administration hospitals in Lexington, under the direction of Dr. Steve Kraman, were the first to implement this policy in the United States. As a result, the VA saw a dramatic drop in the amount of funds spent on malpractice claims. However, instead of this practice spreading throughout Kentucky, the next health-care system to implement it was the University of Michigan.

In Kentucky, there are hospital board members who are required to sign non-disclosure forms. And we do not have public disclosure of the rate of infections at our facilities. Not only do patients have a right to know this, but non-disclosure adversely affects the ability to address any superbug epidemic on a community level.

As I look back at the haunting incident early in my career, I am most bothered that I apologized for my actions. Now I would reserve the words, "I'm sorry," for the patients who have been harmed.