The Ghost in the System: Lifting Healthcare’s Black Veil

“Everyone wears a black veil.”
— Nathaniel Hawthorne, The Minister’s Black Veil

The scariest thing in healthcare isn’t disease. It’s the silence that follows. The test result that never comes; the message marked “read” but never answered; the feeling that someone knows more than they are saying. No one means to build a haunted system. But every unreturned call, every unspoken doubt, and every missed follow-up adds another layer to the veil between patient and provider, until neither can see clearly anymore.

In The Minister’s Black Veil, Reverend Hooper’s covering is meant not to conceal, but to reveal a deeper truth: everyone carries something they would rather not face. Healthcare has its own version of that discomfort. Most patients assume that if something serious appeared on a test, someone would call. But research tells a different story. A systematic review published in the Journal of General Internal Medicine found that seven percent of abnormal test results are never communicated to patients (Callen et al., 2012). At scale, that translates into millions of missed or delayed notifications every year. The consequences are not theoretical. Another study found that nearly one in ten diagnostic errors stem from failures in test result communication (Singh et al., 2014). These lapses are rarely due to negligence. They happen because our systems are fragmented, our inboxes are overflowing, and our assumptions about who will follow up go unchecked.

The result is a slow erosion of trust. A woman waits weeks for biopsy results that never arrive. A man assumes his labs were “fine” because no one called. A family learns about a missed imaging finding only after the disease has advanced. None of this is intentional, but the harm is real. The ghosts in our healthcare system aren’t malevolent; they’re procedural. They live in the quiet spaces between intention and execution.

If patients fear being forgotten, clinicians often fear being exposed. Medicine, for all its precision, has long been built on a culture of perfectionism. Clinicians are trained to project composure and confidence even when uncertainty is the most honest answer. That pressure to “know everything” leaves little room for vulnerability. Research on patient safety culture consistently shows that fear of blame and punishment remains one of the strongest barriers to transparency (Edmondson, 2018). In the 2023 AHRQ Patient Safety Culture survey, more than sixty percent of hospital staff reported hesitancy to report near misses or safety events because they worried about retaliation or damaging their reputation (AHRQ, 2023). So clinicians stay quiet. They wait to speak until they are sure. They soften their language to protect both themselves and their institutions. The intention is to maintain professionalism, but what patients often experience is distance.

That distance carries consequences. When providers hesitate to say “I don’t know yet,” patients interpret the silence as indifference. When systems hide their uncertainty, patients fill in the blanks with fear. In this way, the veil in healthcare (like Hooper’s) becomes both barrier and mirror. It reflects our shared discomfort with imperfection.

Healthcare’s veil isn’t made of secrecy alone. It’s woven from the sheer complexity of the system itself. Electronic health records were meant to unify care, but often, they do the opposite. A JAMA Internal Medicine analysis found that primary care physicians spend nearly two hours per day outside of clinic hours managing EMR inboxes (Tai-Seale et al., 2021). That equates to about nine extra hours each week spent sorting test results, responding to messages, and managing alerts. In that flood of information, urgent issues can become invisible. Follow-up instructions are lost in the shuffle. Notes are copied forward instead of rewritten. Patients log into portals filled with cryptic abbreviations, red flags, and auto-generated comments they can’t interpret. The technology that promised transparency often obscures it. What was once a conversation has become a checklist. What was once a story has become a data field.

For those who try to pierce that silence, the cost can be high. Clinicians who report errors, admit uncertainty, or raise safety concerns often experience stress, anxiety, and professional isolation (Jackson et al., 2014). In medicine, truth-telling can still come with penalties. And yet, the evidence is clear: when providers communicate openly, outcomes improve. A review in BMJ Quality & Safety found that patient trust, satisfaction, and adherence all increase when safety concerns are discussed transparently (O’Hara et al., 2018). Honesty does not weaken confidence—it restores it. Transparency is not about perfection; it’s about presence. It means being willing to say, “Here’s what we know. Here’s what we don’t. And here’s what we’ll do next.” That kind of honesty may not feel heroic, but it is profoundly human.

Lifting the veil does not mean assigning blame; it means choosing to see clearly. Patients can start by asking direct questions: “When should I expect results?” “Who will call me?” “What should I do if I don’t hear back?” Clinicians can start by naming uncertainty without shame: “Your results are still pending, but I’ll follow up when they’re complete.” “I don’t know yet, but let’s figure it out together.” And systems can start by creating cultures that reward honesty instead of punishing it—cultures where communication safety is valued as highly as medication safety. Most people in healthcare want to do the right thing; they simply need a structure that makes it possible.

At Storyline Health Navigation, we often meet patients who are trying to make sense of gaps no one has explained. They come with partial records, fragmented test results, and a sense that something important was lost along the way. We also meet clinicians who share the same frustration—working inside systems that reward volume over understanding and checkboxes over connection. The ghosts in healthcare aren’t villains. They are artifacts of a system that has forgotten how to tell its own story. But stories can be reclaimed. When patients finally understand what happened, why it happened, and what to do next, confusion turns into confidence. That moment, when understanding replaces uncertainty, is what lifting the veil looks like.

We built a creature and called it healthcare. It saves lives, but it also hides behind process and fear. The question now is whether we will face it… or keep pretending it’s still beautiful.

References

Agency for Healthcare Research and Quality. (2023). Survey on Patient Safety Culture: Hospital Database Report. Rockville, MD: U.S. Department of Health and Human Services.

Callen, J. L., Westbrook, J. I., Georgiou, A., & Li, J. (2012). Failure to follow-up test results for ambulatory patients: A systematic review. Journal of General Internal Medicine, 27(10), 1334–1348. https://doi.org/10.1007/s11606-011-1949-5

Edmondson, A. C. (2018). The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth. Wiley.

Jackson, D., Peters, K., Andrew, S., Edenborough, M., Halcomb, E., Luck, L., Salamonson, Y., & Wilkes, L. (2014). Understanding whistleblowing: Qualitative insights from nurse whistleblowers. Journal of Advanced Nursing, 70(1), 123–132. https://doi.org/10.1111/jan.12178

O’Hara, J. K., et al. (2018). A systematic review of patient involvement in safety: The role of effective communication and transparency. BMJ Quality & Safety, 27(9), 763–774. https://doi.org/10.1136/bmjqs-2017-007651

Singh, H., Giardina, T. D., Meyer, A. N. D., Forjuoh, S. N., Reis, M. D., & Thomas, E. J. (2014). Types and origins of diagnostic errors in primary care settings. JAMA Internal Medicine, 173(6), 418–425. https://doi.org/10.1001/jamainternmed.2013.2777

Tai-Seale, M., Olson, C. W., Li, J., Chan, A. S., Morikawa, C., Durbin, M., O’Malley, P. G., & Chen, Q. (2021). Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine. JAMA Internal Medicine, 176(4), 538–540. https://doi.org/10.1001/jamainternmed.2015.6892