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Bedside
Manners: Curb your Docs My
senior partner strutted down the hall in our office, ‘bearing’
a close resemblance to Balloo from Jungle Book. As he drew near,
under his breath I could hear the strains of the immortal tune… ”Zippidy
Doo Dah, Zippity Yay… Yes!!!!
We’d done it! We had proven that doctors COULD be trained! Hiding
my smile, I stepped back into my office, closed the door, and telephoned
Linda, an endoscopy nurse at the hospital. Whether
doctors can be trained or manipulated is not really open to question…
you really don’t think that the pharmaceutical industry spends
so much money on pens and pads emblazoned with drug names because
they want to make sure that our children have enough writing implements?
Nah, I’m sure that a bunch of money has been spent proving
that we docs are quite suggestible and subliminally directed. But
now we’d proved that we could do it in a clinical setting. The
scam—we wanted to see if we could subliminally plant a song
in the brain of a physician.The locale- at the endoscopy suite of
our local hospital, we would have Linda, one of the two nurses staffing
his room over a couple hours, hum a preselected song under her breath
while working with him. We chose carefully—it had to be infectious,
but not too deviant—imaging not being able to rid yourself
of “It’s a Small World After All”!?! My role was
to measure the outcome…had the inoculation taken? It
had worked, and David had no idea where the cheery tune, not heard
perhaps for decades, had sprung. We had achieved mind control! Why
should you care? Well, much of the responsibility for our ongoing
nursing shortage, after low wages and erratic schedules, comes from
the incivility of our doctor and colleagues. And not only does this
rude behavior lead to staff shortages and departure from careers
in medicine—uncivil behavior can have a negative impact on
patient outcomes as shown in studies in the ICU setting by Shortell
(1994) and Knaus (1986). Patients in uncivil and mean environments
were shown variously to have higher death rates or longer lengths
of stay in the hospital. Civil units had an easier time retaining
their nursing staffs. Thus, we need to teach hospital staff the
tools to take control over rude behavior in our hospitals, both
for our patients’ sakes and for the staff’s own well-being.
Please
note that David had lost the song by morning. I do not preach that
we can change your doctors or co-workers overall behaviors, alter
personality forever, or cure cancer. However, when I read about
control of obnoxious behavior in others being impossible, that “you
can only change your own reactions to it”, I say an unqualified
“Horse feathers”! What a passive and psychologically injurious
way to allow others to wound you with verbal aggression. Physicians
and your co-workers are smart, and are trainable. We are at least
as smart as dogs, perhaps not as smart as cats. You will not be
able to affect a life charge, a persona change. But you should be
able to train us to act in an appropriate manner when around you,
the trainer. Lets
carry this dog-training analogy along further. A vicious pit bull
can get trained, but is no less vicious. A retriever is trainable,
but started out lovable. We do not propose to change the basic nature
of the beast, just to school them in appropriate collegial behavior. Lets
talk about what usually happens when a doctor acts up. The current
scenario at most hospitals are that the doctor gets “cranky”,
and then takes it out on the nurses. The abused nurse speaks to
the charge nurse, who asks her to report it in writing to administration.
Several days later, it is received in administration, reviewed by
committee, and a form letter is generated after the next scheduled
committee meeting in about a month telling the doc to “be nicer
to the nurses”, but being very vague on details. The doctor’s
miffed. He/she can’t recall the incident, and had someone told
them of the problem, then they could have corrected their actions.
Miffed, the pissed-off doctor goes on rounds, and the world continues
to spin on its unending cycle. What
is this like to the offending doctor in dog terms? Think of the
doctor as a somewhat clueless puppy, newly acquired, who has just
piddled in the middle of your new white living room rug. You’re
upset immediately, but don’t say anything to the dog. Then
one month goes by, and… WHAM!!!
Out comes your rolled up newspaper! And
the puppy thinks…. “HUH? What’d I do?” No
way to train a dog, is it? Here’s
the thing—you’ve got to hit us with the newspaper right
at the time of the event if you want to make a change in our behavior.
It will take a commitment on your part, but you will end up with
a well-trained dog over time, at least in your home and specifically
with regards to piddling. Thus
we need to teach specific behavior training techniques for verbal
aggression in the hospital setting. The rolled up newspaper (figuratively
please!) is quite direct, and most of us are not brave enough to
face the offender down. However there are some oblique and even
subliminal behavior modifications that you can implement to control
the behavior of your docs and your more unruly colleagues. If
you choose to take control and change your working environment,
you must remember three things: Be
persistent. Be
consistent. Be
insistent.
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About Dr. Raymond • Speaking Topics • Articles • The Sanity Store • Sensational Free Stuff Subscribe to Passionate Health Care Newsletter Subscribe to Your Health Choice Newsletter Patricia L. Raymond, MD FACP FACG 757-547-0368 • 757-547-7727(Fax) • PLRaymond at RxForSanity.com All Rights Reserved. © 2007 Patricia L. Raymond |
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