John J. Ryan: Trust in health care means acknowledging mistakes

Admitting mistakes is the first step toward healing.

(Patrick Semansky | AP photo) In this Dec. 22 photo, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, prepares to receive his first dose of the COVID-19 vaccine at the National Institutes of Health in Bethesda, Md.

To truly trust our health care system, we must acknowledge that there are failures within this system. Our medicines and surgeries only work to a certain extent and by studying these failures we can see the impact, for example, that social determinants of health and inequity have had on adverse outcomes in health.

In recording these failures, and noticing patterns, we can become more aware of trends, and biases. By addressing these, or by putting safeguards in place to limit their impact, we can contribute to the professional growth of our providers, the quality of care from our institutions and healthier communities overall.

Although there remains a sense of shame and embarrassment in our failures, the willingness of healthcare to continue to improve upon itself and learn from its mistakes, is one of the aspects that makes me proud to work in this field.

However, there have been efforts to undermine the trust with our health care system, in recent months, which in no small part is derived from a failure to understand our efforts to better ourselves.

Take Sen. Marco Rubio, for example, who recently stated “Dr. Fauci lied about masks in March. Dr. Fauci has been distorting the level of vaccination needed for herd immunity. It isn’t just him. Many in elite bubbles believe the American public doesn’t know ‘what’s good for them’ so they need to be tricked into ‘doing the right thing’.”

Anthony Fauci did not “lie” about masks. Our knowledge about masks evolved, in a similar way to which our knowledge about school openings and herd immunity continue to evolve. This effort to improve and correct oneself should add to the trust that communities have in the health care systems that deliver their care, not detract from them.

Relationships require trust, whether they are in the family room or the operating room. And health care has at times betrayed that trust with rushed approvals of medicines, unethical experiments and fabrication of data. This has contributed to a growth of nonevidence-based industries, which compete with medicine, but without the oversight and regulation.

However, in line with the social justice movement that has been awakened in this country over the past year, the health care industry and the people that comprise it have started to acknowledge and address the continued need to improve the outcomes in medicine, in particular as it pertains to communities of color.

We need to explain and correct the disparities that exist in everything from life expectancy to laboratory analysis to medication prescription. As in any relationship, an effort to admit fault, and correct mistakes, should help build a foundation of trust between the health care systems, their providers, and the individuals and communities they serve.

This is not an effort to celebrate failure, but rather to recognize it and build off of it. For my own part, I have created a failure resume. I update this resume more regularly than my academic resume. I record the events that did not go well, leadership positions that failed, papers and grants that were rejected. Looking at this I can see trends, patterns and opportunities to help decrease the chance of failure in the future.

Irish Nobel Laureate Samuel Beckett has written “Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.”

Beckett felt that all life ended ultimately in failure, and he encouraged us to acknowledge failure as a constant. Now, although it is hard to accept this fatalistic view as it pertains to health care, as we care for our patients and help them make decisions over their lives, we must acknowledge that for many patients, we do not get to “try again” or “fail again.”

As a health care system, we can try again, and adapt, based on reviews and recommendations, but for our patients and for their families, we only get one chance. Therefore, in these instances where mistakes were made, where dogma was proven to be wrong, admitting our mistakes is the first step towards healing, and preventing it from happening to another family.

Our efforts to publicly correct ourselves and our motivation to transparently acquire more data should not be discouraged, but rather held as an example as to how to build trust, and in turn will help us and our community build healthier lives.

John J. Ryan, M.D.

John J. Ryan, M.D., is an associate professor in the Department of Medicine and the director of the Pulmonary Hypertension Comprehensive Care Center at the University of Utah.