October 24, 2012
“Disrespect..is the elephant in the hospital”
Pacific Standard reports, “Why Patients Leave Hospitals With a Bad Taste In Their Mouths.”
It’s a reminder of the work of Lucian Leape of the Harvard School of Public Health. Excerpts:
- he believes that disrespectful behaviorour ability to tolerate it, and not do anything about itis the root cause of the dysfunctional culture we have in medicine. Its a culture thats hurting an awful lot of people, he says. And he is not just talking about nurses and patients.
- In a pair of papers published in July in the journal Academic Medicine, Leape and his co-authors outlined six categories of disrespect, ranging from the obvious to the subtle. On one end lies the overtly disruptive behavior: the angry outbursts, swearing, and bullying. More common is humiliating and demeaning treatment (by teachers to medical students, surgeons to nurses, physicians to patients). But there are also behaviors and attitudes that we might not think of as disrespect: passive-aggression (harshly criticizing colleagues to psychologically harm them), passive disrespect born of apathy and burnout (I dont have to wash my hands), and dismissive treatment of patients (refusing to return their calls or answer their questions).
- The final category may be the most crucial for changing hospital culturesand the most difficult to combat. Leape and his co-authors refer to this as the systemic disrespect thats baked into the profession. Its why doctors wont admit error for fear of malpractice suits and keep patients waiting. Its also why physicians are required to work excessive hours. When doctors work all night, Leape said after his lecture, theyre more likely to hurt somebody. And so you are deliberately putting them in a position where they may hurt somebody. And thats very disrespectfulto the doctors and to their patients.
- Doctors have always felt entitledwe teach them that in medical school, Leape said in Washington. Thats the challenge. How do you teach them to know a lot and really be outstanding at what they do and not feel that they need to be treated specially?