My last blog post was on how breakdowns in communication between doctors and nurses are the main source of medical malpractice in the Emergency Room.
Why are their problems in doctor-nurse communications? The white paper mentioned in my last post lays the blame at the feet of technology: nurses input data into computer systems and doctors don’t check the database – everyone’s communicating virtually and no one is relaying information face-to-face.
But an even bigger reason why doctors and nurses sometimes don’t communicate well is the problem of physician bullying of nurses. Theresa Brown, author and oncology nurse, wrote about the phenomenon last week in a New York Times editorial entitled, “Physician, Heel Thyself.” As Brown writes, “while many hospitals have anti-bullying policies on the books, too few see it as a serious issue.”
MDs engage in a wide range of bullying behaviors. We can all readily call to mind the image of the narcissistic surgeon going into full melt-down mode and throwing a temper tantrum, but, as Brown writes:
“…the most damaging bullying is not flagrant and does not fit the stereotype of a surgeon having a tantrum in the operating room. It is passive, like not answering pages or phone calls, and tends toward the subtle: condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward insults.”
Physician bullying not only takes a psychological toll on nurses but also gravely endangers patient safety. As Brown writes:
“A 2004 survey by the Institute for Safe Medication Practices found that workplace bullying posed a critical problem for patient safety: rather than bring their questions about medication orders to a difficult doctor, almost half the health care personnel surveyed said they would rather keep silent. Furthermore, 7 percent of the respondents said that in the past year they had been involved in a medication error in which intimidation was at least partly responsible.”
Florida and other states want to reduce the costs of medical malpractice by instituting draconian “reforms” of medical malpractice law. It would probably be a lot cheaper, and patients better off, if hospitals simply worked to improve doctors’ civility toward nurses.