In the foreword to a new collection of essays, Silence Kills: Speaking Out and Saving Lives, Karen Feinstein of the Jewish Healthcare Foundation, which funded the project, offers one of those smoking-gun statistics. Half of doctors, nurses and administrators surveyed by the American Association of Critical Care Nurses say they have witnessed serious medical mistakes, broken rules and incompetence. What is more troubling is that only 10 percent ever speak up about it. Another 25 percent say they’d rather quit or leave their profession than confront these problems.

This code of silence is what gives the book its title and its material. But speaking out and saving lives is not what most of the characters in the 12 personal essays do. The hope of the book is to show just how many ways health care goes wrong and why errors are so easy to ignore. We would all do well to learn from these cautionary tales and speak up when we encounter similar situations in our personal and professional lives.

Each story rightly implies that silence in the face of a medical misdeed is as bad as bad medicine itself. Systemic failure is unavoidable when the system is built on the vagaries of human decision-making and the many frailties of human nature.

As Feinstein notes, it is in vogue to develop systemic approaches to reducing errors. This is known as “human-proofing” health care, a worthwhile conceit but, in most of these stories, a conceit nonetheless:

• There’s the doctor whose intuition told him a patient was having a heart attack, though tests came back negative. His efforts to admit the patient are thwarted by another physician bent on keeping hospital admissions down that night. The patient dies at home a few hours later.
• There are times when it’s clear that systemic change, like the curbing of influence peddling, could do some good. A lab technician knew a doctor’s prescription was based not on the interests of the patient but on the fondness for the pharmaceutical company that paid for his fishing trips. But the tech says nothing and when he eventually quits, the satisfaction is hollow.
• There are the moments when it’s hard to see how anything but human fallibility is to blame. An ever-cautious ophthalmologist somehow fails to diagnose the cancer growing on his granddaughter’s retina. Was he blinded by fear? When the cancer is eventually diagnosed, it is too late to save the girl’s eye.

In most of the stories, there is a crossroads. Had the ethical or medically prudent course been taken, the patient, the doctor or the family member would have been spared suffering. But the essays make clear that while most errors are small, all are cumulative. Each decision entails a set of choices and each choice must be made successfully to get patient care right in the end. The complexity is astounding, almost scary, especially when so many decisions are left to the whims of circumstance.

Solutions are not the realm of this book, and they shouldn’t be. In the United States, one person’s problem is another’s business opportunity, as any employer trying to improve the health of its employees knows.

This is the third collection of essays devoted to health care edited by Lee Gutkind, founder of the journal Creative Nonfiction. To be effective, these collections must be focused, since health care is too broad to cover without some kind of theme. And each book has increasingly followed this course. Still, if there is a fourth book on health care, and I hope there is, I would suggest it capture some of the other perspectives in the field. Surely there is the pharmaceutical executive, the benefits administrator for a large employer, the health insurance salesman who has the literary chops to tell his or her own story of health care malfeasance, indifference or greed.

Honest health care stories may cause embarrassment or risk getting someone in trouble, but authenticity is what makes these stories compelling. What makes them necessary reading, however, is their ability to help doctors and hospital administrators better understand patients. The stories also can help employers appreciate just how complex a doctor’s task is—something they should keep in mind as they embark on efforts to rate physicians for the care they give.