Trust Should Be Earned
Historically, doctors are among those most trusted by Americans. To maintain that trust, medical reformers have launched an array of initiatives designed to bolster the integrity of doctor-patient relationships:• Teaching doctors to admit fault and express remorse for mistakes. In our litigious society, this goes against doctors' instincts, but a 2006 study showed that doctors' apologies help reestablish a patient's trust.
• An early focus on problem physicians. Research shows that doctors disciplined by their state medical boards were three times as likely to have exhibited unprofessional behavior when they were medical students. "The tradition of professionalism must begin in medical school," says study author Dr. Maxine Papadakis, a professor of clinical medicine at the University of California, San Francisco.
• Continuing doctors' ethics education. Dr. Susan Dorr Goold, a pioneer of this trend, says conversations about ethics must occur in classrooms, examining rooms and even hospital hallways. "The more you make it separate, the more marginalized it is," says Goold, an assistant professor of internal medicine at the University of Michigan.
"The people who know what's going on are on the inside," says Rosemary Gibson, coauthor of Wall of Silence, a book about this phenomenon. "But there's more courage now. More of them are speaking out."
Meanwhile, families dissatisfied with their medical care are also prompting reform. In September 2001, Patty Skolnik's son, Michael, passed out suddenly. A Denver doctor said the young man had a tiny brain cyst that could be removed in a three-hour surgery. After a six-hour operation, no cyst was found -- and there were grim complications. Michael was left paralyzed, partially blind and psychotic. He spent 32 months in the hospital before dying at age 25.
State authorities didn't find the surgeon at fault, but Michael's family wasn't mollified. "The doctor basically killed Michael that day," says Patty Skolnik. Later she learned that the physician had a malpractice case pending against him in Georgia. Skolnik lobbied her state legislature, met with lawmakers and testified for a proposed statute requiring physicians seeking or renewing a Colorado medical license to report all malpractice settlements or disciplinary actions against them.
Skolnik found some solace last May when she stood behind Colorado Governor Bill Ritter at the statehouse as he signed House Bill 1331, known as the Michael Skolnik Medical Transparency Act. Skolnik is ready to take her crusade to the next level and is talking with other consumer activists about pushing legislation in Washington.
"I had to do something," she says. "My son's not coming back." Thanks to her, though, perhaps someone else's son won't be lost.
Make a Difference
For advice on monitoring problem doctors in your state, contact Patty Skolnik, a one-woman clearinghouse, at coloradocitizensforaccountability.org or 303-691-9339. Other resources:
• Consumers Union, now active in this field; consumersunion.org.
• Helen Haskell, Mothers Against Medical Errors
• Wall of Silence, a call to arms for more accountability in medical care. The book's authors donate its proceeds to patient support groups.
Michael Crowley is a senior editor at The New Republic.
Outraged? Write to Michael Crowley.



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