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University of Washington Medical Center Educating Patients/vs.Nature and Causes of Disrespectful Behavior by Physicians

June 2nd, 2012 by Sharon O'Hara

Greetings!

I’ve recently returned from a couple days at the University of Washington Medical Center Hospital going through tests I’d only read about and where they ultimately stuck a very long needle in my belly and pumped one and a half gallons of blackish fluid from a tumor that took over the space.

Did you know that an x-ray of a belly full of fluid shows up as a blackish nothing?  I didn’t.

Next time I have a few things to say about that including showing photos of incredible shots taken of the inside of my belly drained of the excess fluid and showing the tumor still taking up an inordinate amount of space.

The attending doctor, Brian Story Porter, MD, took the time to show me the photos on a computer in my room and then showed them a second time when my daughter was there.  More proof that UWMC doctor’s not only teach medical students, they educate their patients too and have all along!

My lung doctor, Christopher Goss, MD – looks at the whole patient – not just their lungs.  His patients are more than a lung, including his disease passion, Cystic Fibrosis.

That said,  I was shocked yesterday to run across the following Perspective: A Culture of Respect, Part 1 and 2: The Nature and Causes of Disrespectful Behavior by Physicians and thought you’d be interested too.

I am running most of it here.  I’m also asking what we, as patients, can do to help change it?

***

“22 May 2012

Perspective: A Culture of Respect, Part 1: The Nature and Causes of Disrespectful Behavior by Physicians

Leape, Lucian L. MD; Shore, Miles F. MD; Dienstag, Jules L. MD; Mayer, Robert J. MD; Edgman-Levitan, Susan PA; Meyer, Gregg S. MD, MSc; Healy, Gerald B. MD

A substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect. The authors identify a broad range of disrespectful conduct, suggesting six categories for classifying disrespectful behavior in the health care setting: disruptive behavior; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behavior; passive disrespect; dismissive treatment of patients; and systemic disrespect.

 

At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change. Even more common are lesser degrees of disrespectful conduct toward patients that are taken for granted and not recognized by health workers as disrespectful.

 

Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients. Disrespect underlies the tensions and dissatisfactions that diminish joy and fulfillment in work for all health care workers and contributes to turnover of highly qualified staff. Disrespectful behavior is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture. A major contributor to disrespectful behavior is the stressful health care environment, particularly the presence of “production pressure,” such as the requirement to see a high volume of patients.

 

(C) 2012 Association of American Medical Colleges

http://journals.lww.com/academicmedicine/Abstract/publishahead/Perspective___A_Culture_of_Respect,_Part_1___The.99620.aspx

Perspective: A Culture of Respect, Part 2: Creating a Culture of Respect

 

Leape, Lucian L. MD; Shore, Miles F. MD; Dienstag, Jules L. MD; Mayer, Robert J. MD; Edgman-Levitan, Susan PA; Meyer, Gregg S. MD, MSc; Healy, Gerald B. MD

 

Creating a culture of respect is the essential first step in a health care organization’s journey to becoming a safe, high-reliability organization that provides a supportive and nurturing environment and a workplace that enables staff to engage wholeheartedly in their work. A culture of respect requires that the institution develop effective methods for responding to episodes of disrespectful behavior while also initiating the cultural changes needed to prevent such episodes from occurring. Both responding to and preventing disrespect are major challenges for the organization’s leader, who must create the preconditions for change, lead in establishing and enforcing policies, enable frontline worker engagement, and facilitate the creation of a safe learning environment.

 

When disrespectful behavior occurs, it must be addressed consistently and transparently. Central to an effective response is a code of conduct that establishes unequivocally the expectation that everyone is entitled to be treated with courtesy, honesty, respect, and dignity. The code must be enforced fairly through a clear and explicit process and applied consistently regardless of rank or station.

 

Creating a culture of respect requires action on many fronts: modeling respectful conduct, educating students, physicians, and nonphysicians on appropriate behavior, conducting performance evaluations to identify those in need of help, providing counseling and training when needed, and supporting frontline changes that increase the sense of fairness, transparency, collaboration, and individual responsibility.

 

(C) 2012 Association of American Medical Colleges”

http://journals.lww.com/academicmedicine/Abstract/publishahead/Perspective___A_Culture_of_Respect,_Part_2__.99622.aspx

***

It all started with Chronic Obstructive Pulmonary Disease and a forty-year smoking habit.

Thanks for reading…. Sharon O’Hara

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This is a patient to patient blog to exchange information and resources...from COPD (Chronic Obstructive Pulmonary Disease) to Arthritis to Cellulites to Sarcoidosis to Sleep Apnea to RLS to Psoriasis to Support Groups to Caregivers and all points in between. Written by Sharon O'Hara.

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