I've written quite a bit about rude, arrogant, and insensitive doctors. Dr. Gooser stars in in The No Asshole Rule (note the artist's rendition above, which Value Rich magazine provided to go along with the text on page on page 21) and my post on Dr. Gooser about digs into evidence showing that bullying is especially prevalent in medicine. On the brighter side of things, new guidelines by the Joint Commission (which regulates U.S. hospitals) mean that those hospitals that let bullies run rampant risk losing accreditation. Also, one of the most heartening notes I ever got from a doctor was about how -- after suffering so much abuse from attending physicians during their medical training -- he and his fellow residents vowed to treat residents and nurses with respect when they rose to more powerful positions. A vow, he reported, that all had kept (see this post). I've also written about the impressive efforts that some hospitals and doctors are beginning to take to reduce medical errors, especially in neonatal intensive care units.
As such, I was intrigued to see a story in the science section of today's New York Times that discussed how nasty and arrogant doctors not only drive nurses out of the profession, they also can create a climate that causes more medical errors. Here is one example from the story:
In one instance witnessed by Dr. Angood of the Joint Commission, a nurse called a surgeon to come and verify his next surgical patient and to mark the spot where the operation would be done. The harried surgeon yelled at the nurse to get the patient ready herself. When he showed up late to the operating room, he did not realize the surgery site was mismarked and operated on the wrong part.
“The surgeon then berated the entire team for their error and continued to denigrate them to others, when the error was the surgeon’s because he failed to cooperate in the process,” Dr. Angood said.
A hostile environment erodes cooperation and a sense of commitment to high-quality care, Dr. Angood said, and that increases the risk of medical errors.
Check out the rest of the article here plus the accompanying piece on "The Six Habits of Highly Respectful Physicians."
I have been keeping track of the problem of nastiness in hospitals -- especially by doctors -- for a few years and I have been disturbed by how more and more evidence keeps coming out about the damage done by such widespread nastiness. But I am heartened by the serious steps that are apparently being taken to tackle the problem -- including by the Joint Commission.
My mother was ill will a lung infection and dementia. She had a very high fever and the doctor said to bring her in to the hospital.
We did and told everyone her situation. They insisted on treating her like any other patient even though we told them she had dementia and was going to be very difficult. We asked if they could sedate her before doing anything. They wouldn't. Instead, they used an anal thermometer on her and laughed while she screamed bloody murder. It was horrible and undignified. I felt so bad for her. I held her hand and tried to calm her down. They also insisted on putting her unnecessarily through all these tests when we knew what was wrong with her. She had already been more than adequately diagnosed by some of the best doctors in Manhattan but apparently when you go into hospital none of it is valid! Then they quarantined her. I wanted to switch hospitals or take her home but my father refused. The whole experience was a nightmare and she died in that stinking place. Someone recently said that hospitals were invented for cost-effective treatment of large amounts of people, not for quality care. Judging by the number of elderly who die in hospital of pneumonia makes me tend to agree.
Am I wrong?
Posted by: Joy | December 11, 2008 at 09:51 PM
Referring to all these comments I would like to oppose to the idea that is given us by the articles and comments that make generalizations about doctors being the major assholes.
A doctor myself my experience and what I heard from lots of German hospitals is different. The overall cast here is: admin-nurse-doctor, with the exception of the majority of head doctors and their allegiance within a very hierarchical and secluded system (see: power makes the jerk, here they are!).
Admin and government dictating diagnosis and therapy, even where and for how long to practice, lowering the gross earnings (as a surrogate for appreciation in our western societies) of most doctors to that of their assistance personnel - at the most.
Nursing staff refusing to nurse and care and do what they are employed for, intrusively encroaching upon doctors duties (leaving the responsibility to them however) and massively bullying preferably young and female residents.
Disrespect and asshole-behaviour goes the other way round, too, as you might see.
If asshole-behaviour is tolerated and supported by certain authorities or if you are an authority whose main interest it is to maintain or gain power (and it is all about power in life) it does not matter if you are a nurse or doctor.
Posted by: Christine Goepfert | December 09, 2008 at 01:51 AM
Hello Bob,
I have limited experience with hospitals but I had the chance to work as consultant to "rescue" an academic hospital from bankruptcy.
Being used to work with large corporations, this was a shock:
- a cast system (doctors-nurses-admin) like I have never seen
- to make it worse, all doctors are men, all nurses are women (almost)
- no governance, a constant political game and lobbying exercise
- uninformed decisions on management
- at least, there was no greed as it was an academic hospital (not the place to make money if you are a doctor in Europe) ... but this was used to justify everything and anything
But I also encountered very intelligent and dedicated people, truly working to improve others' life; very impressive
What I take away is a feeling of fragility hidden behind a lot of inertia; a bit like an ancient civilization that would survive by keeping its old rituals but that is bound to disappear
Greg
Posted by: Haouka | December 07, 2008 at 07:11 AM
I didn't realize that physicians had a reputation for being assholes. I guess the characters on the sitcom "Scrubs" might be more realistic than I thought!
Posted by: Kevin Rutkowski | December 04, 2008 at 09:32 AM
What are your thoughts on Lean health care?
http://runningahospital.blogspot.com
http://www.createhealthcarevalue.com/blog/
Posted by: Jason Yip | December 03, 2008 at 06:56 PM
Hi Bob,
I just got on your site to send you a link to the article because when I read it I knew it was just the thing you would want to write about. Glad to see you beat me to it.
Tori
Posted by: Tori | December 03, 2008 at 11:42 AM
I have mixed feelings about doctors. Of course, they are people, and are a mixed bag like the rest of us.
When I was in med school, I recall that everyone seemed to be jerks. But then I got held back a year, and the people in the next class seemed to be fairly nice people.
It was only years later that I realized that I had been a complete asshole myself so I had no ground to stand on.
I think our system really sucks for picking people to be doctors because it focuses too much on academic achievement, which I do not think is that important to make a good doctor. People don't want the smartest doctor, they want a caring person. People who aren't smart enough to be a doctor will never pass the tests in med school. People that are too mean to be doctors will often excel in the tough med school environment. We have this system and wonder why docs are often mean. I had friends who would have been great docs, but they didn't get into med school b/c they messed up in a class or two. That's not fair as they are really smart _and_ kind.
After I dropped out, I briefly became a nurse. I noticed that almost all the doctors in the hospital were great both kind and intelligent. I was so happy to work for them. So not all doctors are bad. Their job is tough and they are mostly deep in debt. For the amount of work, I actually think doctors are paid just enough and some are even underpaid. It's a job I could never do.
Posted by: Leeroy Glinchy | December 03, 2008 at 09:07 AM
I wouldn't bang the Happy Gong too soon. While it's nice to know that regulatory agencies have noticed the problem, hospitals will use new rules and regulations to keep physicians and surgeons who make them money, and will get rid of physicians who are "dysruptive." Being in a Business School, you would associate disruptive with disruptive innovation, a good thing. "Disruptive" to administrators means physicians are troublesome to them for one reason or another. Nurse abuse is hardly ever the reason. A law firm in Pittsburgh, Horty-Springer, specializes in helping hospitals to get rid of "disruptive" physicians. Usually the mechanism involves the willing complicity of fellow physicians, through a process called "sham peer review."
The best bet to rid hospitals of nurse abuse is to enable nurses to bring complaints before their peers, and have those decisions enforced at medical staff level.
Have a good day,
Brad Evans
Posted by: Bradley Evans | December 02, 2008 at 05:04 PM