Julie Salamon has been guest posting here on the themes covered in her new book, Hospital. This is her last post.
Rudeness isn’t new to the medical profession. In the original charter of the American Medical Association, approved more than 150 years ago, physicians were warned to “avoid all contumelious and sarcastic remarks.”
But now the medical community acknowledges that bad behavior isn’t just about manners. It can harm patients and result in serious financial consequences for hospitals through loss of efficiency and decreased productivity.
Last week the Joint Commission on Accreditation of Hospitals issued a “sentinel event alert,” which warned that “rude language and hostile behavior among health care professionals goes beyond being unpleasant and poses a serious threat to patient safety and the overall quality of care.” By January 1, 2009, the 15,000 hospitals, nursing homes, and other health agencies monitored by the Joint Commission will be required “to create a code of conduct that defines acceptable and unacceptable behaviors and to establish a formal process for managing unacceptable behavior.”
This week the American Hospital Association’s Hospital and Health Networks published an article on the subject under this headline: “The right culture can result in the right outcomes and help avoid costly litigation.”
The New York Times recently reported that doctors are being advised to apologize to patients as a way to fend off malpractice suits.
Momentum has been building. Three years ago a publication from the National Institutes of Health reported, “Dysfunctional nurse-physician communication has been linked to medication errors, patient injuries, and patient deaths.”
About that time, Maimonides Medical Center in Brooklyn began a program to encourage employees to follow the hospital’s Code of Mutual Respect, whose provisions include this one: “The Medical Staff agrees to refrain from any behavior that is deemed to be intimidating, including but not limited to using foul language or shouting, physical throwing of objects …”
The program coincided with the year I spent immersed at the hospital to write a book. During that time, a senior nurse explained,
Think about it. You can’t do surgery without your instruments. Our instrument techs make thirty thousand dollars a year, and we expect them to be these highly skilled, ambitious people who are going to make sure the tray is going to be built exactly the way the surgeon wants it. But they don’t have the same drive the surgeon has. It’s not the same drive even a nurse may have.
How do you motivate someone who makes twelve dollars an hour? By saying, “Your next raise you’re getting another twelve cents?” I think what beats them down is the hierarchy — the respect they’re given or not given. Everyone beats down on the one below.
Here is the hospital’s “respect survey” and how people have responded over the past three years:
The Joint Commission might urge medical people to follow the advice of Maimonides, the 12th century philosopher and physician who wrote: “The perfect man needs to inspect his moral habits continually, weigh his actions, and reflect upon the state of his soul every single day.”
Will more self-scrutiny help avoid litigation and improve patient care?
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to jz-md: you are correct. But I think that the physician has the responsibility to try and ascertain his/her audience and respond appropriately, not just lump all patients together. As a customer, I deserve individual treatment.
to pup-md: yes, you are correct as well. Doing this will take more time.
I have heard so many many people complain that doctors don’t tell them when they don’t know something.
The question I ask everyone who whinges to me about this is “How many times did you admit you didn’t know something today? Or apologise because you screwed up?”
In almost EVERY case, the answer is “I didn’t”
Give Medico’s a break – Which would you prefer:
1) A doctor focusing on that he didn’t hurt your feelings
or
2) One who is focused, to the exclusion of ANYTHING else, on making you better and NOT screwing up.
Also – I have a close circle of friends who are mainly nurses – how do they describe their job? “Doc’s make your body better, we make you feel like we care. Don’t bother the doc’s with emotions, that’s our job”
I completely agree that kindness wards off litigation- even if the staff screws up, the family will be less likely to sue- in the end, it’s caring which bonds patient and practitioner.
ps- contumelious??- this must somehow show that doctors back then were much more literate than now
When I was in college I worked for a studio on the weekends shooting weddings. The owner stressed one thing, be super nice to the bride and her family. The reason was two fold, one it was their special day so add to the joy and two in the event of a screw up with the equipment or processing they will be more forgiving in the event their wedding pictures are screwed up.
In the medical profession as in all professions accidents happen and mistakes are made. If the family remembers a doctor who cares and is nice and respectful, they will extend a certain amount of grace to the doctor and be less apt to sue. If the doctor is an arrogant prick and makes a mistake they will have no problem suing them.
It is a simple human principle, if we like someone we give them a pass. If we don’t like them we want justice and blood. A good example is our current president. The same people who wanted Clinton’s head on a stake for purgery dealing with his sexual harassment suit are more than willing to give Bush a pass for a war that has cost countless lives and billions of dollars.
I can’t believe you are promoting Immortal Technique!! I love you all! Immortal Technique has the sickest rhymes of any emcee alive today. It’s true that his lyrics are extremely political, but if you can get past that (or even enjoy it) then you will find a very talented lyricist.
Go Tech! Go Freakonomics!
I don’t know about the US, but I’m in the UK and I see nurses smiling, being polite etc as WAY down on the list of priorities. The British politics blog Nought Point Zero touches upon these points in this post: http://noughtpointzero.blogspot.com/2008/07/our-brief-nhs-experience.html
To summarise: it’s quality and efficiency that matters most and politeness is about 50th on the list of priorities, in my view.
As a surgeon, I do not condone intimidating behavior directed at staff, nor do I criticize staff in a personal manner. I am however, very critical of myself and how I conduct an operation because that is how I was trained to behave-as a perfectionist who will only accept a perfect outcome. This leads to high stress levels-does it get any more stressful than the obligation to do your best to repair a person who has placed the ultimate trust in you? We are do our best everyday, and yes mistakes occur, some of which are preventable. The raging doctor either does not exist anymore or is on his or her deathbed, the one who throws instruments (assault), propostions nurses (harrassment-by the way, its a two way street), or curses out staff (suspensions occur including loss of priviliges). When doctors are rude, why not try to find out why? Maybe a drug seeker whined and threatened a lawsuit, maybe a patient pathology came back with incurable cancer, maybe the doctor was called all night long for 3 nights and did not sleep. These are not excuses, they are reality and the general public has no clue and does not want a clue, they want Dempsey and Clooney telling them everything is ok. That is not medicine, it is fiction. We try our best but even the best have bad days, everyone does.