October 24, 2012

“Disrespect..is the elephant in the hospital”

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Lucian Leape

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 behavior—our ability to tolerate it, and not do anything about it—is the root cause of the dysfunctional culture we have in medicine.” It’s a culture that’s 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 don’t 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 cultures—and the most difficult to combat. Leape and his co-authors refer to this as the “systemic” disrespect that’s baked into the profession. It’s why doctors won’t admit error for fear of malpractice suits and keep patients waiting. It’s also why physicians are required to work excessive hours. When doctors work all night, Leape said after his lecture, “they’re more likely to hurt somebody. And so you are deliberately putting them in a position where they may hurt somebody. And that’s very disrespectful”—to the doctors and to their patients.

“Doctors have always felt entitled—we teach them that in medical school,” Leape said in Washington. “That’s 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?”

Comments (4)

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Janet Carey

October 28, 2012 at 3:02 pm

I worked at a hospital where the ‘public face’ is respect for patients, yet the management did not offer the same respect for the employees. Bullying was commonplace, and those who tried to stand up for themselves were fired. How can this culture of disrespect possibly be helpful for patient care? I, for one, do not believe that it can.

Leslie Kitchin

October 29, 2012 at 11:46 am

Wow – very interesting to run across this article as I was bullied out of a job at my community hospital. Their motto is “People First.” I’m not sure which people they’re talking about. I was so disillusioned by what happened to me I got out of medicine entirely. Now I work for a non-profit making much less money, but the work environment is respectful and professional. Working in medicine is stressful enough without having to deal with bullying and dysfunction. It’s unfortunate because some of the best people in my field won’t work at our hospital and it’s the hospital’s loss. The department I worked for continually gets low patient ratings, but they seem at a loss to know why. The people who could tell them and help them make the department better are shown the door and human resources doesn’t care at all. I’ve completely lost respect for the hospital.