Expand+Health Affairs, 22, no. 2 (2003): 103-112
doi: 10.1377/hlthaff.22.2.103
© 2003 by Project HOPE


Patient Safety

The Silence
Michael L. Millenson

Despite several well-crafted Institute of Medicine (IOM) reports, there remains within health care a persistent refusal to confront providers responsibility for severe quality problems. There is a silence of deedfailing to take corrective actionsand of wordfailing to discuss openly the true consequences of that inertia. These silences distort public policy, delay change, and, by leading (albeit inadvertently) to thousands of patient deaths, undermine professionalism. The IOM quality committee, to retain its moral authority, should forgo issuing more reports and instead lead an emergency corrective-action campaign comparable to Flexners crusade against charlatan medical schools.


...To remain silent and indifferent is the greatest sin of all.
Elie Wiesel

Nine years ago, while researching the book that would become Demanding Medical Excellence: Doctors and Accountability in the Information Age, I began to catalog the extraordinary number of avoidable patient deaths and injuries attributable to poor-quality medical care. The magnitude of the toll first left me stunned, then depressed, and finally outraged. As I ultimately wrote:

From ulcers to urinary tract infections, tonsils to organ transplants, back pain to breast cancer, asthma to arteriosclerosis, the evidence is irrefutable. Tens of thousands of patients have died or been injured year after year because readily available information was not usedand is not being used todayto guide their care. If one counts the lives lost to preventable medical mistakes, the toll reaches the hundreds of thousands.1
ҹ https://content.healthaffairs.org/content/22/2/103.full
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