What would you do if you discovered that conditions at your hospital posed a threat to patient safety? Let's say you reported the problem to your supervisor, and got no response. Would you then go to the hospital's administrator or CEO? Say you do, but he also refuses to deal with the problem. Then what? Would you file a formal report, or contact state or federal health officials?

If you do decide to blow the whistle, chances are you won't be rewarded for your efforts. In fact, you're more likely to be labeled a troublemaker or "disruptive physician." And if you persist in pursuing your cause, you could risk losing your staff privileges or your job.

If that scenario sounds overly dramatic, consider what happened to the following physicians:

In 2001, Klein sent a memo to his supervisor stating that unless conditions improved, he would refuse to work in the department. The response: he was removed from clinical duties. Although his privileges were quickly reinstated, he was required to work under supervision. He refused to accept that restriction.

In 2002, Klein sued the university, the medical school, and his supervisor under the state's whistleblower law. So far, however, his legal efforts have been unsuccessful. The trial judge granted summary judgment for the defendants, and the appellate court has upheld that ruling.

Klein, now 62, is still a tenured professor at the university, but he no longer has privileges at the hospital, with which he's still engaged in litigation. "This battle has cost me hundreds of thousands of dollars so far, and it's destroyed my career as a practicing physician," he says. "But if I had to do it over again, I would, because this is an ethical issue."

After emergency physician David Lemonick joined the ED at Pittsburgh's Western Pennsylvania Hospital in 2000, he repeatedly complained to his department chairman about various patient safety problems. The chairman reacted with hostility, says Lemonick.

Over the next few years, a series of incidents at the ED alarmed Lemonick. According to his account, there were often dangerous delays in getting blood work done or ECGs read for patients with serious conditions. When one patient suffered an MI as a result of such a delay, Lemonick complained to the nurse manager. She apparently notified the department chairman, who admonished Lemonick for speaking to the nurse in an inappropriate manner.

In September 2004, a patient suffered cardiac arrest two hours after arriving at the ED, which Lemonick attributed to a delay by the nursing staff in sending his blood work to the lab. That same month, after he reprimanded a resident for repeated lapses in patient care, the department chairman accused him of "disruptive behavior."

In October 2004, Lemonick wrote to the hospital's CEO to express his concerns about patient care, and his fear of retaliation for reporting them. Lemonick claims the CEO thanked him, promised an investigation, and assured him there would be no such retaliation. One month later, however, when Lemonick reported for work, he was informed that he'd been terminated.

Last May, Lemonick sued the hospital for violating Pennsylvania's whistleblower protection law and another state law that specifically protects healthcare workers from retaliation for reporting a "serious event or incident" involving patient safety. The case hasn't been scheduled for trial yet, but a hospital spokesman calls Lemonick's allegations "groundless."

Lemonick has since found a new job as director of emergency medicine at a small hospital about 50 miles from his Pittsburgh home, but he's bitter about his experience. "I tried to reveal some serious problems with patient safety at that hospital," he says, "and I hope some good will come of it. But meanwhile, I've essentially been exiled as a troublemaker."