Menus Subscribe Search

Follow us


(PHOTO: PRYZMAT/SHUTTERSTOCK)

(PHOTO: PRYZMAT/SHUTTERSTOCK)

Why Patients Leave Hospitals With a Bad Taste In Their Mouths

• October 16, 2012 • 4:00 AM

(PHOTO: PRYZMAT/SHUTTERSTOCK)

There’s one big reason that we often overlook, a Harvard professor says.

Disrespect, Lucian Leape believes, is the elephant in the hospital.

According to the adjunct professor of health policy at the Harvard School of Public Health, disrespect is the reason why so many patients leave the E.R. feeling belittled or ignored. It’s why medical workers feel so “demoralized.” And it’s why—despite attempts at change in the last decade—we still see medical errors that cause needless suffering and even cost lives.

Thirteen years ago, the Institute of Medicine released a groundbreaking report titled “To Err is Human” that called for a new paradigm in the medical field. Bad people don’t cause errors, the report’s authors said—bad systems do. At the time, studies estimated that as many as 98,000 patients died in American hospitals each year because of preventable medical mistakes, more than were lost to car crashes, breast cancer, or AIDS (though the exact number is difficult to pin down). The solution, the IOM suggested, was not to punish “bad apples” who miscalculated a drug dose. Rather, it was to learn from those errors to build a safer heath care system.

This was supposed to mark a turning point in medicine. But even as we’ve made important strides—for example, the famous “checklist” from Atul Gawande has been proven to reduce surgical mistakes by reminding physicians of simple things like hand-washing—studies still show that somewhere around 15 percent of patients suffer treatment-related complications, about half of which are preventable.

That’s where Leape, a long-time advocate and researcher of patient safety, comes in. As he recently told a roomful of social scientists at a Washington symposium, he believes “that 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.” It’s a culture that’s hurting “an awful lot of people,” he says. And he is not just talking about nurses and patients.

In a pair of papers published in July in the journal Academic Medicine, Leape and his co-authors outlined six categories of disrespect, ranging from the obvious to the subtle. On one end lies the overtly disruptive behavior: the angry outbursts, swearing, and bullying. More common is humiliating and demeaning treatment (by teachers to medical students, surgeons to nurses, physicians to patients). But there are also behaviors and attitudes that we might not think of as “disrespect”: passive-aggression (harshly criticizing colleagues to psychologically harm them), passive disrespect born of apathy and burnout (“I don’t have to wash my hands”), and dismissive treatment of patients (refusing to return their calls or answer their questions).

The final category may be the most crucial for changing hospital cultures—and the most difficult to combat. Leape and his co-authors refer to this as the “systemic” disrespect that’s baked into the profession. It’s why doctors won’t admit error for fear of malpractice suits and keep patients waiting. It’s also why physicians are required to work excessive hours. When doctors work all night, Leape said after his lecture, “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”—to the doctors and to their patients.

So far, the idea is too new to know how large swathes of the field will react to it. Indeed, one might think that the very culture Leape is critiquing might prevent doctors and medical schools from embracing his diagnosis.

In their papers, Leape and his co-authors spell out a few strategies to eradicate this culture of disrespect—starting with medical school deans and hospital CEOs. A new expectation of respect, they suggest, must be built into hospital codes of conduct and performance reviews, as well into the very culture of medical education.

That’s where his audience in Washington comes in. The solution may lie with social scientists. The healthcare field needs them, he believes, to research what it will take to dislodge medicine’s deeply rooted traditions of individualism over collaboration, “education by humiliation,” and disregard for patients themselves.

“Doctors have always felt entitled—we teach them that in medical school,” Leape said in Washington. “That’s the challenge. How do you teach them to know a lot and really be outstanding at what they do and not feel that they need to be treated specially?”

If only the answer were as simple as hand-washing.

Emily Badger
Emily Badger is a freelance writer living in the Washington, D.C. area who has contributed to The New York Times, International Herald Tribune and The Christian Science Monitor. She previously covered college sports for the Orlando Sentinel and lived and reported in France.

More From Emily Badger

A weekly roundup of the best of Pacific Standard and PSmag.com, delivered straight to your inbox.

Recent Posts

November 21 • 4:00 PM

Why Are America’s Poorest Toddlers Being Over-Prescribed ADHD Drugs?

Against all medical guidelines, children who are two and three years old are getting diagnosed with ADHD and treated with Adderall and other stimulants. It may be shocking, but it’s perfectly legal.



November 21 • 2:00 PM

The Best Moms Let Mess Happen

That’s the message of a Bounty commercial that reminds this sociologist of Sharon Hays’ work on “the ideology of intensive motherhood.”


November 21 • 12:00 PM

Eating Disorders Are Not Just for Women

Men, like women, are affected by our cultural preoccupation with thinness. And refusing to recognize that only makes things worse.


November 21 • 10:00 AM

Queens of the South

Inside Asheville, North Carolina’s 7th annual Miss Gay Latina pageant.


November 21 • 9:12 AM

‘Shirtstorm’ and Sexism in Science

Following the recent T-shirt controversy, it’s clear that sexism in science persists. But the forces driving the gender gap are still being debated.


November 21 • 8:00 AM

What Makes a Film Successful in 2014?

Domestic box office earnings are no longer a reliable metric.



November 21 • 6:00 AM

What Makes a City Unhappy?

According to the National Bureau of Economic Research, Dana McMahan splits time between two of the country’s unhappiest cities. She set out to explore the causes of the happiness deficits.


November 21 • 5:04 AM

Sufferers of Social Anxiety Disorder, Your Friends Like You

The first study of friends’ perceptions suggest they know something’s off with their pals but like them just the same.


November 21 • 4:00 AM

In 2001 Study, Black Celebrities Judged Harshly in Rape Cases

When accused of rape, black celebrities were viewed more negatively than non-celebrities. The opposite was true of whites.


November 20 • 4:00 PM

Women, Kink, and Sex Addiction: It’s Not Like the Movies

The popular view is that if a woman is into BDSM she’s probably a sex addict, and vice versa. In fact, most kinky women are perfectly happy—and possibly healthier than their vanilla counterparts.


November 20 • 2:00 PM

A Majority of Middle-Class Black Children Will Be Poorer as Adults

The disturbing findings of a new study.


November 20 • 12:00 PM

Standing Up for My Group by Kicking Yours

Members of a minority ethnic group are less likely to express support for gay equality if they believe their own group suffers from discrimination.


November 20 • 10:00 AM

For Juvenile Records, It’s ‘Justice by Geography’

A new study finds an inconsistent patchwork of policies across states for how juvenile records are sealed and expunged.


November 20 • 8:00 AM

Surviving the Secret Childhood Trauma of a Parent’s Drug Addiction

As a young girl, Alana Levinson struggled with the shame of her father’s substance abuse. But when she looked more deeply into the research on children of drug-addicted parents, she realized society’s “conspiracy of silence” was keeping her—and possibly millions of others—from adequately dealing with the experience.



November 20 • 6:00 AM

Extreme Weather, Caused by Climate Change, Is Here. Can Nike Prepare You?

Following the approach we often see from companies marketing products before big storms, Nike focuses on climate change science in the promotion of its latest line of base-layer apparel. Is it a sign that more Americans are taking climate change seriously? Don’t get your hopes up.


November 20 • 5:00 AM

How Old Brains Learn New Tricks

A new study shows that the neural plasticity needed for learning doesn’t vanish as we age—it just moves.


November 20 • 4:00 AM

The FBI’s Dangerous Misrepresentation of Encryption Law

The FBI no more deserves a direct line to your data than it deserves to intercept your mail at the post office. But it doesn’t want you to know that.


November 20 • 2:00 AM

Brain Drain Is Economic Development

It may be hard to see unless you shift your focus from places to people, but both destination and source can benefit from “brain drain.”


November 19 • 9:00 PM

Gays Rights Are Great, but Ixnay on the PDAs

New research suggests both heterosexuals and gay men are uncomfortable with public same-sex kissing.


November 19 • 4:00 PM

The Red Cross’ Own Employees Doubt the Charity’s Ethics

Survey results obtained by ProPublica also show a crisis of trust in the charity’s senior leadership.



November 19 • 2:00 PM

Egg Freezing Isn’t the Feminist Issue You Think It Is

New benefits being offered by Apple and Facebook probably aren’t about discouraging women from becoming mothers at a “natural” age.


Follow us


Sufferers of Social Anxiety Disorder, Your Friends Like You

The first study of friends' perceptions suggest they know something's off with their pals but like them just the same.

Standing Up for My Group by Kicking Yours

Members of a minority ethnic group are less likely to express support for gay equality if they believe their own group suffers from discrimination.

How Old Brains Learn New Tricks

A new study shows that the neural plasticity needed for learning doesn't vanish as we age—it just moves.

Ethnic Diversity Deflates Market Bubbles

But it's not in the rainbow and sing-along way you'd hope for. We just don't trust outsiders' judgments.

Online Brain Exercises Are Probably Useless

Even under the guidance of a specialist trainer, computer-based brain exercises have only modest benefits, a new analysis shows.

The Big One

One company, Comcast, will control up to 40 percent of Internet service coverage in the U.S., and 19 of the top 20 cable markets, if a proposed merger with Time Warner Cable is approved by regulators. November/December 2014

Copyright © 2014 by Pacific Standard and The Miller-McCune Center for Research, Media, and Public Policy. All Rights Reserved.