Perspective: A Culture of Respect, Part I: The Nature and Causes of Disrespectful Behavior by Physicians

Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 05/2012; 87(7):845-52. DOI: 10.1097/ACM.0b013e318258338d
Source: PubMed


A substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect. The authors identify a broad range of disrespectful conduct, suggesting six categories for classifying disrespectful behavior in the health care setting: disruptive behavior; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behavior; passive disrespect; dismissive treatment of patients; and systemic disrespect.At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change. Even more common are lesser degrees of disrespectful conduct toward patients that are taken for granted and not recognized by health workers as disrespectful.Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients. Disrespect underlies the tensions and dissatisfactions that diminish joy and fulfillment in work for all health care workers and contributes to turnover of highly qualified staff. Disrespectful behavior is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture. A major contributor to disrespectful behavior is the stressful health care environment, particularly the presence of "production pressure," such as the requirement to see a high volume of patients.

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    • "Reduced rates of substance disorder diagnoses in our population may reflect a combination of improved recognition, diagnosis and treatment as well as decreasing stigmatization of addicted physicians. Physician behavior that interferes with the optimal functioning of healthcare teams [30] [31] can be detrimental to the culture of (clinical) safety [32]. Actions or speech by a physician that demeans, upsets or disrespects others decreases the ability of the clinical team to achieve its intended outcomes [33]. "
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