Free Speech in Hospitals?

The terror in Paris settled quickly but will flare again. Some people hate freedom and democracy. Some people believe they have a duty to punish those who say things they do not like.

Just as talk shows ran out of content, another hostage crisis erupted. Pundits comment and debate the slaughter. One theme focuses on freedom and the limits of expression in a free society.

Hospital workers also wrestle with free speech. What can they say without getting into trouble? Do they have a duty to report? Will they be protected if they hold an unpopular opinion?

In a time of universal deceit, telling the truth is a revolutionary act. George Orwell

Free Speech in Hospitals

In healthcare, ‘speaking up’ usually focuses on whistleblowing:

• Medical Whistle-blower Protection Lacking CMAJ 
• Doctors Fear Losing Hospital Privileges for Speaking out
• Tar Sands Whistle-blower
• Dr. Olivieri
• MD Whistleblower canned in NHS
• Is Whistleblowing Worth It? Medical Economics

But can healthcare providers speak out on anything else? Should they?

Currying Favour with Politicians

Just after training, I wrote a letter to the editor about overcrowding in emergency departments. I asked the Minister of Health if he really knew what he was talking about. I invited him into our ED at “—Blank— Hospital” to see overcrowding for himself, to experience it firsthand.

My CEO blew up. He sicced the Chief of Staff on me. Then the President of the Medical Staff Association preached, “Never, ever, ever mention the name of the hospital in the media.”

My department chief said he agreed with my letter, thanked me for writing it and asked me to never do it again, ever.

Hospitals fight over one pot of tax dollars in Medicare. Thus, hospitals must never embarrass their political benefactors. Hospitals can lose project funding because one politician got their image tarnished. Image determines re-election, the most important political concern.

The public pays for hospital administrators to spend hours and hours in dozens of meetings worrying about “the media” or “the union bus getting parked outside” or a letter of complaint copied to the local MPP and hospital CEO. Dozens of meetings!  In a way, administrators care about public image just as much as politicians.

Free Speech Fallacy

Those who know cannot speak.

Those at the coal face often know frontline problems better than CEOs, bureaucrats or journalists. But they cannot speak. If they do, they get in trouble, lose positions or promotions, and might get fired. Even worse, they might make work much harder for colleagues. Is this free speech?

Rules of “Free Speech”

Publish accolades and praise without fear. But if you have less than glowing comments, do not identify:

• your organization.
• an individual by name.
• specifics of a bad outcome you report.

Never comment on

• concerns about safety.
• decisions made by organizations you work for.
• details about religion, race, sex or any specific identifier even if central to an issue.

Some topics attract more pain and suffering than others.  Avoid big labour, organizational movements and any hint of being politically incorrect. If you do, expect to be shouted down, punished and written off.

Is Free Speech in Hospitals Dead?

What if you’re an idealist? What if you can’t help but speak truth to power?

Go ahead; be an idealist. Talk about rates of this or that terrible thing; talk about ineffective efforts to improve X, Y or Z. (Yes, I’m too chicken to mention specifics!) Say it gently, kindly.

You might be in big trouble or out of work tomorrow. Another martyr for free speech.

photo credit: anonymousartofrevolution.com