Blame Culture

Our individual and collective psyche has become such that we tend to find fault with others and blame someone or something for any unwanted issue. Same is happening in healthcare sector too. As mentioned in the previous post, complications, untoward incidents, and bad outcomes are part of any healthcare delivery system. These happen in the best of the healthcare facilities too.

Whenever and unwanted incident happens, people are quick to point fingers at doctors and hospitals. In the present-day complex healthcare delivery systems, doctors do not have everything in their control, despite the will to control everything and deliver the best possible. In this blame culture, doctors are the easy and soft targets; for public, media, government and regulatory bodies.

This is leading to doctors being defensive and evasive in their interaction with the patients and relatives, leading to more suspicion. It is rather difficult to explain what is happening and why in a critically ill patient to lay people. Sometimes the doctors themselves do not know fully what is happening. They try to do their best and innovate based on their experience.

If the patients are mature enough to discuss the issues and uncertainties involved, the dialogue will be meaningful, and a proper “informed consent” can be taken. Most of the time the consenting process is a farce. Doctors do not have the time or inclination to take a proper informed consent or the patients are not willing to listen to the list of possible complications. When an untoward incident happens, all the hell breaks loose.

There is no transparency in the system, and it is the general tendency of the doctors and hospitals denying any responsibility. Due to this, small proportion of patients who get complications due to shortcomings in service provision are having to fend for themselves. Most of the times, the mishaps are minor and all that needs is an honest approach and an apology. Most people do understand that mistakes can happen and accept.

Some doctor colleagues tend to make loose comments without knowing the full picture. This may be out of simple ignorance or a deliberate smear campaign. Either way, it does not help anyone concerned. Due to the fear of being held accountable and further repercussions, doctors and hospitals are always in denial mode. Patients who have a genuine grievance are having to go through a prolonged legal battle. Most of them do not have the means or inclination to take the doctors to task.

Many countries have taken the concept of “no blame culture” from the airline industry. Due to the nature of civil aviation, it is especially important to investigate any mishaps, so that the aircraft and passenger safety is not compromised. They have a system of reporting any incident without the fear of being made a scapegoat. All the reported incidents are investigated, and appropriate action taken to prevent similar thing happening again. Many hospitals do have this system, but it is not always thorough and transparent.

It is high time it is adopted in our healthcare system too. All untoward incidents must be reported, investigated, and appropriate action taken. Patients must be informed and offered compensation where necessary. If they are not satisfied, they should have access to a quick and fair grievance redressal system. Till such time, we keep blaming each other and our “world-class healthcare” remains a slogan only.