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

October 24 • 4:00 PM

We Need to Normalize Drug Use in Our Society

After the disastrous misconceptions of the 20th century, we’re returning to the idea that drugs are an ordinary part of life experience and no more cause addiction than do other behaviors. This is rational and welcome.


October 24 • 2:00 PM

A Letter to the Next Attorney General: Fix Presidential Pardons

More than two years ago, a series showed that white applicants were far more likely to receive clemency than comparable applicants who were black. Since then, the government has spent hundreds of thousands of dollars on a study, but the pardons system remains unchanged.


October 24 • 12:00 PM

What Makes You So Smart, Middle School Math Teacher?

Noah Davis talks to Vern Williams about what makes middle school—yes, middle school—so great.


October 24 • 10:00 AM

Why DNA Is One of Humanity’s Greatest Inventions

How we’ve co-opted our genetic material to change our world.


October 24 • 8:00 AM

What Do Clowns Think of Clowns?

Three major players weigh in on the current state of the clown.


October 24 • 7:13 AM

There Is No Surge in Illegal Immigration

The overall rate of illegal immigration has actually decreased significantly in the last 10 years. The time is ripe for immigration reform.


October 24 • 6:15 AM

Politicians Really Aren’t Better Decision Makers

Politicians took part in a classic choice experiment but failed to do better than the rest of us.


October 24 • 5:00 AM

Why We Gossip: It’s Really All About Ourselves

New research from the Netherlands finds stories we hear about others help us determine how we’re doing.


October 24 • 2:00 AM

Congratulations, Your City Is Dying!

Don’t take population numbers at face value.


October 23 • 4:00 PM

Of Course Marijuana Addiction Exists

The polarized legalization debate leads to exaggerated claims and denials about pot’s potential harms. The truth lies somewhere in between.


October 23 • 2:00 PM

American Companies Are Getting Way Too Cozy With the National Security Agency

Newly released documents describe “contractual relationships” between the NSA and U.S. companies, as well as undercover operatives.


October 23 • 12:00 PM

The Man Who’s Quantifying New York City

Noah Davis talks to the proprietor of I Quant NY. His methodology: a little something called “addition.”


October 23 • 11:02 AM

Earliest High-Altitude Settlements Found in Peru

Discovery suggests humans adapted to high altitude faster than previously thought.


October 23 • 10:00 AM

The Psychology of Bribery and Corruption

An FBI agent offered up confidential information about a political operative’s enemy in exchange for cash—and they both got caught. What were they thinking?


October 23 • 8:00 AM

Ebola News Gives Me a Guilty Thrill. Am I Crazy?

What it means to feel a little excited about the prospect of a horrific event.


October 23 • 7:04 AM

Why Don’t Men Read Romance Novels?

A lot of men just don’t read fiction, and if they do, structural misogyny drives them away from the genre.


October 23 • 6:00 AM

Why Do Americans Pray?

It depends on how you ask.


October 23 • 4:00 AM

Musicians Are Better Multitaskers

New research from Canada finds trained musicians more efficiently switch from one mental task to another.


October 22 • 4:00 PM

The Last Thing the Women’s Movement Needs Is a Heroic Male Takeover

Is the United Nations’ #HeForShe campaign helping feminism?


October 22 • 2:00 PM

Turning Public Education Into Private Profits

Baker Mitchell is a politically connected North Carolina businessman who celebrates the power of the free market. Every year, millions of public education dollars flow through Mitchell’s chain of four non-profit charter schools to for-profit companies he controls.


October 22 • 12:00 PM

Will the End of a Tax Loophole Kill Off Irish Business and Force Google and Apple to Pay Up?

U.S. technology giants have constructed international offices in Dublin in order to take advantage of favorable tax policies that are now changing. But Ireland might have enough other draws to keep them there even when costs climb.


October 22 • 10:00 AM

Veterans in the Ivory Tower

Why there aren’t enough veterans at America’s top schools—and what some people are trying to do to change that.


October 22 • 8:00 AM

Our Language Prejudices Don’t Make No Sense

We should embrace the fact that there’s no single recipe for English. Making fun of people for replacing “ask” with “aks,” or for frequently using double negatives just makes you look like the unsophisticated one.


October 22 • 7:04 AM

My Politicians Are Better Looking Than Yours

A new study finds we judge the cover by the book—or at least the party.


October 22 • 6:00 AM

How We Form Our Routines

Whether it’s a morning cup of coffee or a glass of warm milk before bed, we all have our habitual processions. The way they become engrained, though, varies from person to person.


Follow us


Politicians Really Aren’t Better Decision Makers

Politicians took part in a classic choice experiment but failed to do better than the rest of us.

Earliest High-Altitude Settlements Found in Peru

Discovery suggests humans adapted to high altitude faster than previously thought.

My Politicians Are Better Looking Than Yours

A new study finds we judge the cover by the book—or at least the party.

That Cigarette Would Make a Great Water Filter

Clean out the ashtray, add some aluminum oxide, and you've (almost) got yourself a low-cost way to remove arsenic from drinking water.

Love and Hate in Israel and Palestine

Psychologists find that parties to a conflict think they're motivated by love while their enemies are motivated by hate.

The Big One

One company, Amazon, controls 67 percent of the e-book market in the United States—down from 90 percent five years ago. September/October 2014 new-big-one-5

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