By Shah-Naz H. Khan, MD 

When we shake our heads at the snake oil salesmen of yesteryears and wonder how the people then could have been so naïve as to fall for the crude shenanigans, we are wearing blinders with our eyes wide open. Malpractice remains alive and well.

Those who care can cite many causes for this blight in our profession. The frequent targets of a doctor’s pointing accusatory finger are the greedy insurance companies and the churlish hospital administration that reduces humans to a dollar amount. In that accusatory stance, three fingers point at ourselves. So, why not first examine our own contribution to vice?

If one distills medicine to its very essence, it is reduced to a patient and the doctor. Or the holy trinity of patient-doctor-nurse. The rest are the important but supporting cast. So, for the health system to rot to its core, doctors must be complicit. We are. We become callous perpetrators or indifferent bystanders. It results in an environment of impunity where malpractice is rampant. The laws and bylaws are no better than window dressing if they go unenforced. If only they were exercised every now and then, to keep in check those contemplating funny business.

There are effective steps we can take that will discourage most from going over to the dark side. Any obstruction at all suddenly brings to question, “everybody does it.” The difficulty arises, as Seneca put it, by knowing the one who is good and another bad for a long time, resulting in both being held in the same regard. Malpractice is unacceptable, whether it is done by a friendly colleague, an ambitious newbie or, that well-entrenched senior physician who gladhands most every physician in the hospital and is on backslapping terms with the administration.

Indifference, silence or, lack of meaningful action is permission. Imagine a neurologist who orders EEG on every consulted patient, no matter what the disease. It is a running joke through the hospital, and he carries on smiling back, with nothing to fear. Until the first time someone questions him. It likely leads to some unpleasance, but it will cause the neurologist to pause and consider the potential untoward consequences.

It may at least reduce his infringements. The spinal surgeon who nails and rods every level of the spine sans indication does so because he has gotten away with it before. The malpractice financially benefits his practice and the hospital. And, those who know better would rather keep their nose clean.

To prevent malpractice, raising concerns must be encouraged and not frowned upon for rocking the boat. Within the hospital, the doctors are the members of peer review or quality control committees and participants of morbidity and mortality conferences. We succumb to using these positions for settling scores, practicing petty politics for personal gain, putting inconvenient practitioners in their place, and sweeping complications under the rug. It goes without saying that when used correctly, these bodies do improve the quality of care. They cannot be misused without the acquiescence of a physician. Peer pressure may make it difficult for a wavering physician to become a rubber stamp for the unsavory elements in health care.

Should our professional bodies protect physicians’ interests to the extent that the first amendment right is curtailed? As I recall, several years ago, a member of one of our professional bodies was dragged through coals and sanctioned, all for being an expert witness whose opinion went against another member sued for malpractice.

The defendant complained to the professional body, which came to the view that the expert witness should have stated what the professional body deemed standard of care and not, what the expert witness’s belief of it was. It smacked of a union punishing someone for ratting, rather than the undertaking of an elevated organization of healers, scholars, and independent thinkers.

Or, maybe the castigation was for speaking up against a proud male neurosurgeon when she was a female? No matter that she was well-known, well-published, an expert, and a leader in her field. During voting on the motion, I hoped that better sense would prevail. For matters such as a training program letting loose upon the world a psychopath and murderer despite red flags, a professional organization doled platitudes about accepting trainees with good character. No sign of holding the trainers (also members of the professional body) to account for an egregious lapse of duty and judgment or avoiding the inconvenience associated with doing the right thing. The same body is helpless in preventing someone from falsely claiming themselves a neurosurgeon.

Physicians have the right to flourish and deserve to be well compensated for what they do. It is possible without harming our patients. We can use our finite resources and time to do so ethically. Or, one may choose to go down the rabbit hole. Ultimately, our choices define us. Accountability does come calling sooner or later. Usually, reputations are not made or tarnished by a single act; rather, they are the summation of behavior or actions of an individual or institution.

It goes without saying that malpractice cannot be wiped away completely. However, it must not be allowed to be widespread and rampant, because we cannot be bothered to check it at all. A saying goes, when you see a wrong, stop it forcefully. If that is not possible, speak up against it. If that is not possible, think it wrong. The last being the weakest form of conviction. Curbing malpractice does not mean holding the sword of Damocles over the head of every physician who provided sound treatment but had an inadvertent complication. We know the difference between malpractice and complications. The majority in our field are upstanding and good. Let not the minority define us. Having put our own house in order, we can then set forth to slay those other dragons that dare tarnish our noble profession. We are the difference, and it is not all that hard.

Shah-Naz H. Khan is a neurosurgeon.