It’s bad enough that many patients leave hospitals with sutures, a bag of pain pills, and a new diagnosis that often carries a “chronic” prognosis. But, according to Harvard professor Lucian Leape, something even more insidious is happening that’s leaving patients with a bad taste in their mouths. He says, “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.”
In many of my blog posts, I’ve been suggesting that the only way we’re going to heal health care is to reclaim medicine’s heart and bring love back to the healing process. So I agree with Leape. Disrespect simply isn’t loving – and it runs rampant in hospital cultures.
Disrespect In Hospitals Runs Rampant
In a pair of papers published in July in the journal Academic Medicine, Leape and his co-authors outlined six categories of disrespect prevalent in hospitals. On one end lies the overtly nasty: the surgeon who throws the bloody scalpel across the OR, the four-letter outbursts, the bullying. More common is the systematic degradation and humiliation of medical students and residents by medical school professors, the contempt dripping from the voice of surgeons as they give orders to nurses, and the way some physicians demoralize and disrespect patients by cutting them off, negating what they say, or simply not listening.
But there are other more insidious behaviors of disrespect that permeate hospital culture: passive-aggression (harshly criticizing colleagues with the intent of psychologically harming them), passive disrespect born of apathy and burnout (“I won’t even bother to return this page from the nurse”), and dismissive treatment of patients (refusing to return their calls or answer their questions).
The final category may be the most disturbing because it’s so ingrained in hospital culture. Leape and his co-authors refer to this as the systemic disrespect that’s baked into the profession, which is all tied up in ego and superiority and fear of being outed as imperfect. It’s why many doctors who make inevitable mistakes won’t admit error for fear of malpractice suits. It’s why doctors keep patients waiting for hours on end without apologizing. It’s why physicians work excessive hours without taking into account that lack of sleep might actually harm the patient. It’s why some doctors start acting like – even believing – that they are Superhuman gods worthy of worship, not fallible humans like all the rest of us.
When doctors work all night, Leape said in this article, “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.”
One Patient’s Story
One patient, a kidney/pancreas transplant recipient, was checking her own lab results when she noticed that some of her lab values were out of whack, suggesting that she might be in the early stages of transplant rejection. Nobody had called to alert her, so she called her doctor’s office but had trouble reaching anyone. Someone finally told her she could come to the office to see the doctor, but that she might have to wait.
So she came and waited, and waited, and waited–all day long.
Nobody every gave her a status update or suggested she might take a lunch break. The doctor never came to apologize or let her know he was doing everything he could to get to her as soon as possible. There was no nurse holding her worried hand or even front desk attendant keeping her in the loop. When she finally saw the doctor at the end of a long day, nobody apologized for failing to notice the abnormal lab values. Nobody acknowledged that she had been waiting for an entire day. Her doctor was in and out before she even got her questions answers. She wound up feeling worthless, helpless, disempowered, and patently disrespected, in addition to feeling anxious that her body might be rejecting her transplants. When she told me this story, she wound up crying hot tears of frustration and humiliation.
Is this how we want our sick patients to feel when they’re already scared, worried, and not feeling well?
So what can we do? How can we bring respect back to the hospital and clinic settings?
It’s going to require a shift of consciousness. As health care providers, we need to remember that we are all humans with equal power and equal rights. Each of us is equally deserving of respect and compassion, whether we’re patients or scrub techs or nurses or med students or doctors. Nobody is “better” than anyone else, and nobody deserves to be relegated to “lesser” status.
This means recognizing this for ourselves. Why should med students stand for abusive treatment? Why do patients allow themselves to be disrespected? Why do nurses grin and bear it when doctors get nasty? Why do doctors think they’re all that?
It all comes back to love. When we remember that our jobs as health care providers give us the opportunity to be true healers, we can reclaim the heart of medicine and choose to treat each other with love and mutual respect. It’s no wonder patients don’t get better when they wind up feeling disrespected. And it’s no wonder so many health care providers are miserable.
This is no way to live. And it’s certainly no way to heal.
Have You Ever Felt Disrespected?
Tell us your stories. Offer your suggestions. How can we bring respect back to health care?
Hoping and praying for the healing of health care,