92 Becoming a Patient
Yet this event—an institutional ritual—was anonymous, and implied
forgiveness and pardon. Unfortunately, nothing had replaced it, leaving
doctors terrified of mistakes and guilt-ridden. Yet medical mishaps can,
of course, be serious or even fatal, and not humorous.
Questions arose of what to do with colleagues’ ‘‘screw-ups’’—whether
and how physicians should handle others’ errors. Harry described how
nurses complained to him about fellow doctors’ care. Nurses could po-
tentially serve as checks on a physician’s care, but were ultimately lim-
ited in their capacity to do so or to intervene.
I was the physician for the nurses, so I always had a special rela-
tionship with them. Sometimes they’d say to me, ‘‘Isn’t there
something to do about this patient? Her doctor doesn’t talk to her,
and she is worried sick about XYZ.’’ Or ‘‘What can I do about Mrs.
So-and-So?’’ There is no mechanism for the nurses to deal with
that. They can’t go to their supervisors. If they went, nothing
would happen.
Yet in the end, physicians’ abilities to influence colleagues’ decisions were
restricted, too. Harry continued:
It’s tough: none of my business, basically. A colleague might be
outraged and complain about the nurses, or say, ‘‘That’s the way
the patient ought to be treated!’’ or ‘‘That’s my patient. That’s the
way to do it.’’ I have enough worries of my own to take on the
world. If the doctor in question was a good friend, I’d chat with
him. But it’s hard to criticize. I’m not the world’s most courageous
person. I don’t want a bloody nose.
Thus, informal checks may exist, but often only if the doctors are close.
However, the lack of such feedback may end up hampering the quality of
care. Moreover, doctors in private practice ‘‘depend on referrals’’ from
colleagues, whom they therefore don’t want to alienate. Physicians also
hesitate to criticize colleagues, rationalizing that ‘‘We all do things wrong.’’
Still, occasionally, feedback worked. Harry added:
One oncologist clearly mistreated patients: overtreated them,
charged them excessively, and kept them too long in the hospital.
Finally, his colleagues rebelled, and went to the chief. He was let
go, went elsewhere, and almost lost his license. So there, a cor-
rective process worked.