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An ounce of prevention against bullying doctors

Print | Comments () Posted by Ishani Ganguli May 10, 2011 04:09 PM

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Short White Coat is a blog about learning to be a doctor. Posts appear here as part of White Coat Notes. Ishani Ganguli is a fifth-year Harvard medical student. E-mail her at shortwhitecoat@gmail.com.

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Theresa Brown’s recent posting in the New York Times Well blog about doctors who bully nurses generated a stir, especially among doctors defending their honor. As a medical student, I’ve witnessed and experienced my share of bullying by a handful of doctors (though to be fair, by nurses as well). In one instance, I watched a surgeon mock a new nurse in the operating room, teaching her with absurd faux-patience how to properly hand him his instruments.

As Brown notes, even subtle condescension and rare altercations impact patient safety. She suggests top-down attitude adjustments and civility training for physician offenders.

But doctors’ attitudes are formed, and so should be influenced, before hierarchies are fully ingrained -- in medical school.

Medical students have little exposure to other health professionals in the first two “pre-clinical” years of school. When we begin our third year, struggling to find our place in the bewildering jungle of the hospital ecosystem, it is all too easy to parrot and thus perpetuate any bad behavior by our superiors. Medical educators blame this on the “hidden curriculum” -- observing real-life practices that can override our textbook learning.

To combat this hidden curriculum, we should draw a lesson from history. In response to emerging concerns in the 1960s that doctors weren’t communicating effectively with patients, educators came up with classes to explicitly teach this skill to trainees. At Harvard, it’s called Patient Doctor and it begins in our first year. Through role play and interviews with volunteer patients, we learn the vocabulary, even seating positions, that allow us to take detailed histories from patients and show empathy for them. Though we thought it cheesy at the time, we carry the skills from this course with us through subsequent years of medical school and no doubt beyond.

Why not teach us in a similar manner how to communicate with nurses, physician assistants, and other members of the health care team? Start with helping us understand, in depth, what each member’s job is.

Yes, the hidden curriculum will continue to counter these bottom-up efforts as long as bad attitudes persist among some full-fledged physicians. But it will be much easier for us to maintain good habits if we form them early; if, for example, instead of just being told that we should be nice to nurses, we practice collaborating on a treatment plan with nursing students.

At dinner last week, I had the chance to chat with a physical therapy student, the girlfriend of my fiancé’s friend and classmate. I was curious about her training and she patiently answered my many questions about it. One of her comments struck me in particular: She told me that her professors inevitably include a few lessons in each lecture about how to talk to doctors, how to phrase recommendations tactfully and in a way that doctors will respond to. Isn’t it arrogant of doctors not to learn similar tactics to communicate with other health professionals?

Here’s the good news: Today, six national health professions associations and three private organizations including the Association of American Medical Colleges released two reports recommending that all students in health fields get interprofessional training (read: how to work in teams) and suggesting ways to implement these lessons in medical, nursing, dental, pharmacy, and public health schools across the country.

This is long overdue attention to a critical issue.

tags medical education, Medical errors, medical school, medical teams, nurses

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About white coat notes

White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at cconaboy@boston.com. Follow her on Twitter: @cconaboy.

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