Hospital bullies take a toll.....

[Wulfman]

http://www.msnbc.msn.com/id/25594124/

Hospital bullies take a toll on patient safety
Bad behavior by doctors and others undercuts morale, leads to errors
By JoNel Aleccia
Health writer
updated 11:03 a.m. MT, Wed., July. 9, 2008

They’re the bullies of the operating room, the browbeaters of bedside manner: doctors, nurses and other clinicians who make a habit of behaving badly.

They yell, they cuss, they throw things. Or they engage in more subversive behaviors: ignoring questions, acting impatient, insulting colleagues or speaking to them in condescending tones.

“It can go from verbal abuse to sexual harassment and physical assault,” said Dianne Felblinger, an associate professor of nursing at the University of Cincinnati who studies medical intimidation.

The acts are bad enough when they affect staff morale, leading to greater turnover and less job satisfaction. But the Joint Commission, a national hospital accrediting agency, warned Wednesday that there’s mounting evidence that such disruptive behaviors are tied to medical errors that can cause patient harm — and that hospitals across the country should no longer tolerate it.

Starting in January, the agency will require hospitals to establish codes of conduct that define inappropriate behaviors and create plans for dealing with them. Suggested actions include better systems to detect and deter unprofessional behavior; more civil responses to patients and families who witness bad acts; and overall training in “basic business etiquette,” including phone skills and people skills for all employees.

The Joint Commission’s first-ever alert about the problem is the latest industry effort to address an issue that has challenged the medical community for years, said Dr. Gerald Hickson, director of the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center in Nashville, Tenn.

“The data is clear that certain members of the team don’t play so well with other members of the medical team,” said Hickson. “We’ve dealt more effectively with drugs and alcohol than we have dealt with the kicking, spitting and cussing.”

Dr. Mark Chassin, president of the Joint Commission, said growing emphasis on preventing medical errors has made it clear that a culture of intimidation contributes to the mistakes.

"It's a problem that goes underreported, threatens patient safety and has become so ingrained in health care that it's rarely talked about," Chassin told reporters Wednesday.

Nearly everyone who has worked in hospitals can recount a tale of bad behavior. Hickson recalled a doctor who hurled a table across a room, sending shards flying back at co-workers. Felblinger remembered when a doctor threw a used needle at a nurse, piercing her skin.

Don't ignore bad behavior
Ignoring bad behavior has potentially serious consequences for patients, said Felblinger, author of an analysis of studies on medical bullying published this spring in the journal of Obstetric, Gynecologic & Neonatal Nursing.

About 70 percent of nurses studied believe there’s a link between disruptive behavior and adverse outcomes, and nearly 25 percent said there was a direct tie between the bad acts and patient mortality, she said.

A 2004 study of workplace intimidation by the Institute for Safe Medication Practices (ISMP) in Horsham, Pa., found that nearly 40 percent of clinicians have kept quiet or ignored concerns about improper medication rather than talk to an intimidating colleague.

Linda Petitt, 54, a clinical nurse specialist in Cincinnati, Ohio, said she went into private practice several years ago because she could no longer tolerate the atmosphere that allowed a doctor to scream and yell in an operating room — with no repercussions.

“He told me: I refuse to talk to you, so now what are you going to do about it?” said Petitt, who was the charge nurse at the time.

Only a small percent are bad actors
Estimates based on malpractice claims suggest that between 4 percent and 6 percent of doctors and other health workers actually engage in intimidation, Hickson said. That’s probably about the same percentage of bad actors in any profession, he added.

But that small proportion has a big impact, said Felblinger.

“I think it is endemic,” she said. “We’ve been so used to having these behaviors occur for so long.”

In the ISMP study of about 2,000 clinicians, more than 90 percent said they’d experienced condescending language or voice intonation; nearly 60 percent had experienced strong verbal abuse and nearly half had encountered negative or threatening body language.

“Some people are intimidated because they think the doctor has the higher authority,” said Renee Setteducato, 55, a nurse at Lutheran Medical Center in Brooklyn, N.Y.

It’s important to note that bad behavior is not limited to doctors, said Dr. Joseph Heyman, chair of the board of directors for the American Medical Association. The Joint Commission warning also covers nurses, pharmacists and other clinicians, he noted.

It's not just doctors
Setteducato observed her share of tantrums and slammed phones in 37 years of nursing. But it’s not just doctors bullying nurses, she said. Nurses do their share of intimidation, too.

“The experienced nurses are not patient with the new doctors,” she observed.

The AMA has had a policy calling for zero tolerance for disruptive behavior for all workers for years. Heyman said he believes the climate is much better now than when he was a resident in the 1970s.

“I don’t see it as a huge problem,” he said, adding: “Having standards encourages hospitals to look for this kind of behavior and head it off at the pass.”

The Joint Commission standards and suggestions will offer hospitals a clear model for establishing guidelines and consequences that will help decrease disruptive behavior, Hickson said. He said he was optimistic that hospitals would actually put the plans into practice, mostly to improve workplace morale, but also to boost patient safety — and head off legal trouble.

Hickson, who researches why patients file medical malpractice lawsuits, says arrogant or insensitive behavior can influence whether people decide to sue. That holds for employees who believe they've been mistreated, too.

“When they feel that a physician doesn’t care for them, he won’t return their calls, won’t answer their questions, those are the kind of events and circumstances that will be the last straw,” he said.

The new guidelines are a fine effort to address a long-standing problem, experts said, but it could take years for a major culture shift. In the meantime, there’s no substitute for professional confidence, said Setteducato, the veteran nurse.

Faced with arrogant doctors or those who scream and throw patient charts on the floor, Setteducato adopts a practiced, calm response. "You have to nip that in the bud," she said.

“I say, ‘You know what, doc? That doesn’t work here. And we’re going to have to do this together as a team. Because that’s what it’s all about.'”
© 2008 MSNBC Interactive

URL: http://www.msnbc.msn.com/id/25594124/

[Mile High Sleeper]

Interesting article.

For more on the Joint Commission, and how to report errors in your care, go to the light bulb above, article Reporting Errors in Your Care,
cpaptalk-articles/preventing-reporting- ... ssion.html

[Guest]

My mother married an MD and bred me.

Three years later they had a very NON-amicable divorce, and retired to opposite corners of the Continent.

Mamma worked in a hospital for years (Ph.D Clinical Chemist).

She always told me MD's were a-holes and to steer clear of them.

Mamma said it. I believe it. That settles it.

LOL,
B.

[echo]

Momma's always right.

[GumbyCT]

Gotta marry one so you can get your own contintent!!!

[mellabella]

My mother married an MD and bred me.

Three years later they had a very NON-amicable divorce, and retired to opposite corners of the Continent.

Mamma worked in a hospital for years (Ph.D Clinical Chemist).

She always told me MD's were a-holes and to steer clear of them.

Mamma said it. I believe it. That settles it.

LOL,
B.

My friend's dad is a doctor (optometrist)--and still happily married to her mom.

However, this same friend did tell me a joke popular in her family:

"What does M.D. stand for?"
"Minor Deity!"

[Babette]

My Father (the MD) is actually a pretty low-key nice guy. Talks your ear off, but is otherwise pretty harmless. As long as you stand up-range of him (gun nut). He was born dirt-poor and didn't pick up alot of the fancy high-handed ways that alot of his peers have.

He is, however, referred to in the family as "The Donald". This nickname pre-dates the "Your Fired" days, but boy does it apply!

He RARELY throws his title around in public. My brother, on the other hand, has impersonated him (calls himself "Dr. X") MANY MANY MANY TIMES to get into fancy restaurants, run up large bills, and generally do all the wild boy things that wild boys like to do. It's a huge family joke. Until the bills start rolling in....

LOL,
Babs

[bap40]

We were very lucky with our current family practice doc. We started seeing him while he was still a resident and willingly took on my husband and daughter and I on as patients. My husband has had 5 brain tumor removals and up until now was having seizures daily. Our doc was the ONLY one who would handle him instead of sending him to a neurologist, excecpt at one point when one became involved during a hospital stay. This ONE had a horrible bedside manner. She told me and my daughter to "shut up" She kept adding more seizure meds and maxed the doses out as high as she could. No one, including the hospital staff could stand her. She was rude, cocky and would not explain a thing. My husband and daughter got the last laugh one day when she came in to his room and was going thru her speil with the zipper down on her pants!!!! I missed it, and sure wish I hadn't. She ended up being fired by the hospital and our family doc, started lowering his drugs as soon as possible and he is doing well.

[Tarma]

Boy, I'm sure glad no one but medical people make mistakes or act like jerks!

[mellabella]

Boy, I'm sure glad no one but medical people make mistakes or act like jerks!

In all fairness, Tarma, I think the hostility comes from the fact that, if I (as a non-M.D.) make an arrogant mistake or act like a jerk....no one's life is ruined.

I had a very smug doc who refused to listen to me for TWO YEARS when I told him his original titration wasn't working for me....refused to order me a retitration even though it was covered by my insurance, all because he insisted he must be right.

His replacement (whom I met when I showed up to "fire" him and get a copy of my files to go elsewhere) WAS willing to order a retest...and found out that my pressure needed to be a full 6 points higher. It totally changed my life....and underlined the fact that I wasted 2 YEARS and lots of $$$ being compliant with a useless CPAP pressure and even more useless followup appointments. In the meantime he prescribed sleeping pills I had crummy reactions to (even though I didn't have trouble falling asleep--I fell asleep all the time!!) and...this was the last straw...offered me a spot in the insomnia clinic!! (If only I was wakeful enough to ever need it, or to be able to make it through one of the evening "classes"...I couldn't stay up past 9pm at that point, I was always so tired.)

I know I've told this story a few times but if it helps one other new CPAPper be assertive about getting heard or walking out the door if they're not....it's worth it. Thank god I didn't stay with that doc a minute longer.

[Insomniyak]

Yesterday I thought this said "Hospital Bullets Take a Toll" which would apply to some places I have seen.

Having worked as a Nurse Aide (mostly in post-op and some in rehab) for 8 years, it turns my stomach when I read that. I can recount there were 2 docs at one place I worked at, one would talk down at the nurses, not even talk to the aides, or listen to patients for that matter. The other doc usually woudl do his rounds with patients on Fridays. He would come in at 2PM and literally go to each and every pt to talk to them, he'd wheel the charts with him and he would listen to feed back on everyone that was involved. Often he stayed til 10PM. A rare and almost non-existant breed.

It would also go up my back-side sideways when other aides or nurses would talk down, not listen to, and in some cases steal from a patient. When I worked at rehab, sometimes we were all these people had, but unfortunately with the way our health care system is today, with less and less people to take care of more patients, I am sure it has gotten worse. I jumped ship 8 years ago out of the healthcare feild, because ( and some may argue with this, HINT) I treated patients the way I wanted to be treated if I was in their situation and when I started to internalize things, I knew I had to leave.