Patient Safety and Physician Silence

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American health care features little patient safety and too much physician silence about injuries. Preventable medical injuries are numerous, and research presents a convincing case that advancing capabilities in patient safety could greatly reduce harm to patients. Safety and silence are not unrelated, as safety analysis starts with disclosure of problems. Two main sets of factors resist patient safety and promote physician silence: internal medical culture and the external sociolegal environment of health care. Recognition of the importance of external accountability, external oversight of medical discipline, and tort compensation should be modified to make it easier for practitioners to do the right thing. Tort liability alternatives are warranted.

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