Menus Subscribe Search
(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

September 19 • 4:00 PM

In Your Own Words: What It’s Like to Get Sued Over Past Debts

Some describe their surprise when they were sued after falling behind on medical and credit card bills.



September 19 • 1:26 PM

For Charitable Products, Sex Doesn’t Sell

Sexy women may turn heads, but for pro-social and charitable products, they won’t change minds.


September 19 • 12:00 PM

Carbon Taxes Really Do Work

A new study shows that taxing carbon dioxide emissions could actually work to reduce greenhouse gases without any negative effects on employment and revenues.


September 19 • 10:00 AM

Why the Poor Remain Poor

A follow-up to “How Being Poor Makes You Poor.”


September 19 • 9:03 AM

Why Science Won’t Defeat Ebola

While science will certainly help, winning the battle against Ebola is a social challenge.


September 19 • 8:00 AM

Burrito Treason in the Lone Star State

Did Meatless Mondays bring down Texas Agriculture Commissioner Todd Staples?


September 19 • 7:31 AM

Savor Good Times, Get Through the Bad Ones—With Categories

Ticking off a category of things to do can feel like progress or a fun time coming to an end.


September 19 • 6:00 AM

The Most Untouchable Man in Sports

How the head of the governing body for the world’s most popular sport freely wields his wildly incompetent power.


September 19 • 4:00 AM

The Danger of Dining With an Overweight Companion

There’s a good chance you’ll eat more unhealthy food.



September 18 • 4:00 PM

Racial Disparity in Imprisonment Inspires White People to Be Even More Tough on Crime

White Americans are more comfortable with punitive and harsh policing and sentencing when they imagine that the people being policed and put in prison are black.



September 18 • 2:00 PM

The Wages of Millions Are Being Seized to Pay Past Debts

A new study provides the first-ever tally of how many employees lose up to a quarter of their paychecks over debts like unpaid credit card or medical bills and student loans.


September 18 • 12:00 PM

When Counterfeit and Contaminated Drugs Are Deadly

The cost and the crackdown, worldwide.


September 18 • 10:00 AM

How Do You Make a Living, Molly Crabapple?

Noah Davis talks to Molly Crapabble about Michelangelo, the Medicis, and the tension between making art and making money.


September 18 • 9:00 AM

Um, Why Are These Professors Creeping on My Facebook Page?

The ethics of student-teacher “intimacy”—on campus and on social media.


September 18 • 8:00 AM

Welcome to the Economy Economy

With the recent introduction of Apple Pay, the Silicon Valley giant is promising to remake how we interact with money. Could iCoin be next?



September 18 • 6:09 AM

How to Build a Better Election

Elimination-style voting is harder to fiddle with than majority rule.


September 18 • 6:00 AM

Homeless on Purpose

The latest entry in a series of interviews about subculture in America.


September 18 • 4:00 AM

Why Original Artworks Move Us More Than Reproductions

Researchers present evidence that hand-created artworks convey an almost magical sense of the artist’s essence.


September 17 • 4:00 PM

Why Gun Control Groups Have Moved Away From an Assault Weapons Ban

A decade after the ban expired, gun control groups say that focusing on other policies will save more American lives.


September 17 • 2:00 PM

Can You Make Two People Like Each Other Just By Telling Them That They Should?

OKCupid manipulates user data in an attempt to find out.


September 17 • 12:00 PM

Understanding ISIL Messaging Through Behavioral Science

By generating propaganda that taps into individuals’ emotional and cognitive states, ISIL is better able motivate people to join their jihad.


Follow us


For Charitable Products, Sex Doesn’t Sell

Sexy women may turn heads, but for pro-social and charitable products, they won't change minds.

Carbon Taxes Really Do Work

A new study shows that taxing carbon dioxide emissions could actually work to reduce greenhouse gases without any negative effects on employment and revenues.

Savor Good Times, Get Through the Bad Ones—With Categories

Ticking off a category of things to do can feel like progress or a fun time coming to an end.

How to Build a Better Election

Elimination-style voting is harder to fiddle with than majority rule.

Do Conspiracy Theorists Feed on Unsuspecting Internet Trolls?

Not literally, but debunkers and satirists do fuel conspiracy theorists' appetites.

The Big One

One in three drivers in Brooklyn's Park Slope—at certain times of day—is just looking for parking. The same goes for drivers in Manhattan's SoHo. September/October 2014 new-big-one-3

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