“The Culture of Silence: Medical errors happen everywhere. No healthcare system, no matter how advanced, is completely free from mistakes. The true test of a system is not whether errors occur, but whether they are acknowledged, investigated, and used to improve care.”
Imagine a surgery that is declared “successful.”
Two days later, the patient is dead.
The family asks: What went wrong? Was there a complication? Could it have been prevented?
The answers never come.
This scenario is, unfortunately, far from unusual.
Culture Of Silence
Medical errors happen everywhere. No healthcare system, no matter how advanced, is completely free from mistakes. The true test of a system is not whether errors occur, but whether they are acknowledged, investigated, and used to improve care.
In Nigeria, that test often fails.
When things go wrong, the typical response is not transparency but silence. Medical records become difficult to access. Explanations are vague or withheld. Internal reviews, if they happen at all, are never made public.
The most serious medical errors are rarely litigated. They are often not even fully acknowledged.
This silence is not accidental. It is structural.
Doctors may hesitate to criticise colleagues out of professional loyalty. Hospitals fear reputational damage and legal liability. Families lack the money, time, and information to fight for answers.
The result is a healthcare system that absorbs its mistakes, instead of exposing them.
The cost is enormous. A system that hides its errors cannot learn from them. And patients are denied the truth. To suffer harm is tragic. To be denied a clear account of that harm is a second injury.
Problem Of Expert Witnesses
When a grieving family finally gathers the resources to seek justice, either before the Medical and Dental Council of Nigeria (MDCN) or in court, another barrier often appears: the expert witness.
In principle, expert witnesses are supposed to help the court with independent, objective opinions. They are meant to be neutral guides.
In practice, concerns have grown about what some call “hired guns”, that is, experts whose opinions seem to serve the party that pays them, rather than the truth.
This is not always deliberate dishonesty. Often, it is more subtle. Professional loyalty can make it hard to criticise a colleague. Fear of damaging one’s reputation may influence an expert’s conclusions. And financial incentives can create unconscious bias.
The result is that the search for truth is compromised.
Nigerian courts use a legal test called the Bolam Principle. In simple language: a doctor is not negligent if their actions are supported by a responsible body of medical opinion, even if other doctors would have done things differently.
This test makes sense. But it depends on that “responsible body of medical opinion” being truly independent. If expert witnesses are biased, the standard becomes self-protective. Negligence becomes harder to prove; not because it didn’t happen, but because the system cannot produce honest evidence.
For patients, this adds insult to injury.
The Law on Paper vs. The Law in Practice
Nigeria does have laws that protect patients.
The National Health Act 2014 affirms the right to dignity and to receive relevant information about your care. This includes, in principle, access to medical records and explanations when treatment goes wrong.
The law of negligence provides a path to compensation if a doctor breaches their duty of care and causes harm. The MDCN is meant to discipline errant practitioners.
But legal rights mean little if they cannot be enforced.
Where reporting systems are weak, where medical records are withheld, and where expert testimony is unreliable, the road from injury to accountability becomes long and uncertain.
A right without a practical way to claim it is just an abstraction.
The Dignity Question
At the heart of this is a question of human dignity.
Patients place their lives and wellbeing in the hands of doctors from a position of vulnerability. That trust creates an obligation—not just to provide competent care, but to be honest when things go wrong.
Transparency is not a courtesy. It is an ethical duty.
A system that withholds the truth does more than evade liability. It breaks the trust that makes healing possible.
None of this ignores the enormous pressure Nigerian doctors face. Unreliable electricity, chronic understaffing, outdated equipment, and poor pay are daily realities. Often, systemic failures cause harm, not individual malice.
But those pressures cannot justify concealment. A profession that asks for the public’s trust must be willing to account for its failures—however difficult the circumstances.
What Must Change
We need more than complaints. We need reform.
First, hospitals—starting with tertiary centres—should adopt mandatory but confidential adverse event reporting systems. The goal is not punishment alone, but learning and prevention.
Second, strengthen independent medical review mechanisms. Serious allegations must be examined impartially by people with technical competence and no stake in the outcome.
Third, set clear ethical and legal standards for expert witnesses. Experts must owe their duty to the court, not to the party that hires them. If testimony is misleading or partisan, sanctions should follow.
Fourth, make medical records and information meaningfully accessible to patients and families, as the National Health Act intended.
Fifth, publish the outcomes of MDCN disciplinary proceedings. Accountability must not only be done, but seen to be done.
The Bottom Line
A healthcare system that hides its errors cannot correct them.
A system that depends on compromised experts cannot reliably expose them.
And a society that tolerates both places patients at risk—not only in the hospital, but in the long struggle for justice that follows.
The question is not whether mistakes will happen. They will.
The question is whether we are prepared to face them—with honesty, with independence, and with a genuine commitment to justice.
Know Your Rights
Your Right
What It Means
Right to information
You are entitled to know what happened during your care, including explanations of adverse outcomes (National Health Act).
Access To Medical Records
You can request your medical records. Hospitals should not unreasonably withhold them.
Right To Complain
You may report suspected negligence to the hospital, the Medical and Dental Council of Nigeria (MDCN), or seek legal redress.
Independence of Expert Witness
In court, experts must give neutral opinions, not partisan testimony. You can challenge biased experts.
