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Unofficial Prognosis

Unofficial Prognosis


Perceptions and prescriptions of a medical student
Unofficial Prognosis Home

Disrespect in hospitals isn’t just unpleasant. It’s unsafe.

The views expressed are those of the author and are not necessarily those of Scientific American.


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Hospital bullies: they’re a minority, but they’re sizable enough that they can unfortunately set the tone for everyone else. Most health care providers have in their arsenal some juicy tales of mistreatment to tell, but most is far less glamorous. It’s micro-aggressions; and this is what creates a culture.

There are many reasons why disrespect is not ideal. Perhaps most obviously, it’s unpleasant for the recipient. No one likes to be yelled at. No one feels good when told she is incompetent. It’s at best mildly discomfiting and at worst can be a nagging source of misery, discouragement, and low self-esteem.

But if that’s not enough to sound alarm for change, consider this. The results are in, and they paint a bleaker, eye-opening picture: When staff are disrespected, medical errors increase. When a team exchanges harsh words, patient care suffers. Suddenly, this isn’t just about staff satisfaction. How your caregivers interact with one another outside your hospital room door has a significant effect on whether an error is going to be made inside it – with your care, with your body.

I wrote a piece in Aeon Magazine today about the link between disrespect and medical errors, and the insidious effect of a medical culture in which even seemingly small acts of aggression and impatience among staff can degrade trust, discourage reporting, and ultimately lead to increased errors and worse patient care. I explore how this plays out and how we can combat it.

Because it’s important that we do. If not for those of us who work in hospitals – for our patients. And we can’t fix it until we recognize it as the quality of care hazard it is.

Ilana Yurkiewicz About the Author: Ilana Yurkiewicz is a fourth-year student at Harvard Medical School who graduated from Yale University with a B.S. in biology. She was an AAAS Mass Media Fellow, and her work has appeared in the New England Journal of Medicine, Aeon Magazine, Science Progress, The News & Observer, and The Best Science Writing Online 2013. She has an academic interest in bioethics, currently conducting ethics research at Harvard after previously interning at the Presidential Commission for the Study of Bioethical Issues. She is also interested in general internal medicine and quality and systems improvement. Follow on Twitter @ilanayurkiewicz.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. jtdwyer 7:58 pm 01/29/2014

    Excellent point, but I also have to point out that caregivers also sometimes belittle and mistreat patients – an experience I suffered during an extended stay in a hospital intensive care unit. Understandably, in such conditions staff can be under extreme pressure, but patients are heavily sedated, have suffered major trauma, are subjected to sleep depriving conditions and may require assistance at inconvenient times.

    In my particular case I could not leave the ICU until my blood pressure dropped, but staff mistreatment was working against that possibility…

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  2. 2. Spironis 3:39 pm 01/30/2014

    patient care suffers. Patients are working fluid. There is always another patient. The singular hospital employee assigns prices to services and materials. Then, Accounts Receivable. Down the list are doctors who assign purchases. Nurses are somewhere between shopkeepers and wage slaves who punch cash registers with pictures not numbers on the keys. The most important nurse qualification is speaking Tagalog.

    American medicine manages to be both astoundingly expensive and poorly effective. Go to a neighborhood clinic that takes cash. Woe unto you if your “testing” requires a computer interface.

    You’ve got cancer chemotherapy. Do a cut-down into the tumor’s arterial blood supply to syringe pump in an extended microdose. Boy, would that ever be administratively stupid, requiring both skill and attention. Slam a big glug it into a cephalic vein. it chews up plumbing through to your vena cava, eats your hearth, eats your lungs, eats your heart some more, shoots to your brain, and eventually dilutes and delivers to the tumor site, more or less. The more they ravage your healthy tissue, the more you will pay to ameliorate it. Be brave – all the really good drugs are reserved for addicts. That’s social compassion for the diverse and deserving.

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  3. 3. hkraznodar 1:36 pm 02/5/2014

    Disrespect in any situation leads to loss of quality, decreased productivity and greater risk to life and health. Unfortunately disrespect is deeply ingrained into American culture from the entertainment we watch to how our politicians behave.

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  4. 4. StevedeBurque 8:40 am 02/18/2014

    The illness is not merely in the hospital, or with the doctor or embedded in the healthcare milieu.
    In our culture, courtesy and respect are by no means encouraged to assimilate into one’s Ego Ideal. The concept itself is as discredited as its originator, Sigmund Freud.
    One may practice respect or courtesy here when one wishes, when one is in a merry mood; but that behavior is no more a duty than a whim.
    When one will step on one’s neighbor to get ahead, thrust others out of the way as impediments, respect for human dignity seems to be an operational flaw; it must be thrust aside itself. In the Roller Derby of medical training and practice, courtesy and dignity rank equivalent to diet, exercise, and the food pyramid – a fictive set of conscientious beliefs to which we must pledge allegiance, but pay no nevermind in actual practice.
    I read with sadness, “caregivers also sometimes belittle and mistreat patients.” How can we get that to stop?

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  5. 5. StevedeBurque 1:31 pm 02/28/2014

    Matt Young, of the American Society of Cataract and Refractive surgery, wrote an article, “A close look at the sociopath physician” in 2013.
    If one reads up on the Axis II pathology of sociopathy and psychopathy, and related topics such as aggressive narcissism and Erich Fromm’s “malignant narcissism,” it is very disquieting to see how these factors are beneficial to success in various fields, and most especially in specialty training, such as medicine, and I’m sure, others such as law and the various fields with high demand and high esteem.
    Disdainful cruelty, in fact, is poorly managed in American culture. It is to some degree admired – as long as the target is an unapproved class of persons. One can consider that a marker for the health of a culture is the ability to sequester and wall off its sociopaths. Our current culture – not so good at it.

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