As I wrote this earlier month, doctors often know when a patient has been the victim of a medical error – sometimes before the patient does.

But too often they don’t say anything about the mistakes, according to a recent report in The New England Journal of Medicine. Feedback to the post was so thoughtful that ProPublica decided to host a Google + hangout about the topic. We invited four experts to join us – two doctors and two patient advocates.

Here are five takeaways from the conversation.

1. The stakes couldn’t be higher for patients. 

Patient advocate Patty Skolnik said that when her son went into surgery, a young doctor who disagreed with the need to do the procedure excused himself from participating but did not say anything to her or the surgeon about the surgery being unnecessary. Her son later died because of injuries sustained in the surgery. Because of the doctor’s silence, “We lost a child,” Skolnik said. So conversations between doctors about medical mistakes can be issues of life and death, she said.

2. Doctors know this is a problem.

Dr. Tom Gallagher, an internist and professor at the University of Washington School of Medicine and lead author of the NEJM study, said he has given more than 200 presentations to doctors about patient safety problems. He said the most physicians often ask him about mistakes by colleagues. “I understand I need to tell the patient about my own mistake,” Gallagher said the doctors tell him, “but what am I to do if I’m aware of a mistake that a colleague has made involving the patient that we’re caring for together. Should I say anything to the patient?”

This uncertainty suggests that doctors too often stay quiet, which means patients are kept in the dark and opportunities to learn and improve the quality of care are lost, Gallagher said.

3. Doctors stay silent for many reasons.

Gallagher said that doctors who suspect a colleague has made a mistake may be uncertain about what happened. They worry about having an awkward conversation with a peer, or about causing a lawsuit or losing a business relationship. Dr. Brant Mittler, a cardiologist and attorney who also represents doctors, said the way doctors review one another’s work is often political. Doctors who have complaints filed against them may be unfairly treated during peer reviews, he said. “The threat of professional ruin is enough to keep doctors from confronting their colleagues,” he said.

Staying silent often means that patients have a hard time getting the care they need after they’ve been the victim of a medical error, said patient advocate Helen Haskell, whose son also died because of a medical error. “When there’s been harm, patients are bounced from one doctor to another trying to find care,” Haskell said.

4. There is a way forward.

Gallagher said the rights of patients and families are more important than the fears doctors have about difficult conversations. As such, physicians are obliged to explore potential errors with their colleagues, not ignore them, he said. The commitment to addressing physician errors directly is also the responsibility of the leaders at medical facilities, he added. “Ultimately we’re calling on physicians and organizations to recognize that accountability and transparency is truly a shared responsibility,” Gallagher said.

5. Putting patients first is a moral and ethical issue.

“Patients are the ones who are putting their lives on the line and the ones who are footing the bill,” Haskell said. They have a right to expect the services for which they contracted.

Skolnik said patients have a right to hear the truth from their doctors. Patients understand that doctors sometimes make mistakes, but they need to be told what happened and what’s being done to keep it from happening again. There’s no wiggle room for doctors, she said.

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