Friday, April 4, 2014

Compassion in Medicine: Why Medical Professions Attract Bullies and how to Stop Them

 Dust storm in New Mexico obscures the Sandia Mountains.

"We decided to move to New Mexico so we could live near our children. During the move, a dust storm kicked up that was so severe the highways were closed. We had to stay at a motel. 

We finally arrived, unpacked, met our neighbors. Oddly, I developed a cough right after we moved, and noticed one of our dogs was coughing, too. I felt like I was coming down with the flu. I woke up in the middle of the night soaked in sweat. My body ached. I was worried about my dog, though, preoccupied with her health as she is an old girl, a bit fragile. I made an appointment to take her to the local vet, then she stopped coughing. I, however, did not. I also could not find a general practitioner to take my insurance. In fact, it took nearly four months to find a general practitioner. 

I finally reached the point where I was so sick that my husband took me to the nearby emergency room. They told me I appeared to have pneumonia, but they had car accident victims coming in so they didn't run tests, they gave me antibiotics instead. I had a severe reaction to the antibiotics and was taken back to the emergency room by ambulance. They hooked me up to an I.V. They checked me in, then rolled my chair beneath the loud television. I was trembling, vomiting, in tremendous pain in my chest, stomach, and back. I asked them to move me, but they said they needed to watch me."


Hospital wheelchairs are not comfortable, and are not built for hours of use by people in extreme pain. Photo by  Artaxerxes Michael J. Farrand.


"Soon, the waiting room filled and one by one patients were taken back to be seen. I was sobbing, I was so sick, in so much pain. One of the patients argued with the receptionist. "Please, take that woman in first," he said. "We were waiting over an hour and she was here with an empty I.V. bag when we arrived. She's sobbing. She can't hold still because she's in so much pain." The receptionist explained that they treat patients according to the severity of the problem.

And then the room was empty. I watched as the kind young man left the ER, shrugged and smiled a sad, apologetic smile at me, then walked out the door. Then everyone left the reception area. It was 45 minutes later when I finally stood and called for someone to remove my I.V. A young man came out and seemed surprised to see me. I knew then that I was either intentionally or accidentally forgotten, left for hours sitting beneath the blasting television, sobbing. I told him to remove the empty I.V. bag from my arm or I would take it out myself. He told me he was just going to try and find someone to treat me--after four hours and an ambulance ride I was supposed to believe someone finally decided I might need help? My teeth were chattering so hard I thought I chipped a tooth! My entire body was screaming with pain from trembling and shaking for so long and I vomited so much I was having dry heaves! I told him to remove the I.V., I was going home. He called a cab for me."

"My condition did not improve and I asked my former insurance representative from Texas to help me find a doctor, but he was also unsuccessful. I still had the cough, flu symptoms, night sweats, headaches, chest pain, muscle aches. Then one afternoon I woke up with so much pain in my chest and such a sever migraine that I thought my head was going to explode. My husband rushed me to the hospital. This time, because I had "Chest Pain," they took me right in. We could hear a woman shouting in a room down the hall. She sounded like she was on drugs. We could hear staff shouting back at her. The atmosphere was tense. 

A few minutes later a nurse came in and told me she was going to treat my headache. She didn't speak clear English. I tried to explain to her that I wanted to make sure someone was going to check my other symptoms. She looked confused and left the room without giving me medication."


Guantanamo Captive's Hospital Beds. Photo  by Department of Defense, public domain. 

Then a nurse practitioner came into the room. She leaned over the bed and started shouting at me. "When I send a nurse in with a needle full of medication she damn well better come back out with an empty needle," she said. She was leaning over the bed, shouting in my face. I felt threatened, frightened, and started shaking uncontrollably. I could feel my heart pounding in my throat, ears, head, body. "If I give an order, those orders are followed, and no one is going to tell me otherwise," she shouted, and she continued to shout, generally repeating herself. My husband remained in his chair. He later told me he was afraid that if he stood up she would claim HE was acting in a threatening manner. He quietly tried to interrupt, to explain that I simply asked if someone was going to check my other symptoms and not just treat the headache, but she raised up her hand so she couldn't see his face. So...I did the same. I raised up my hand so she was no longer spitting on my face when she shouted. I placed my hand over my face so I couldn't see her. With my other hand, I made a peace sign and waved it back and forth. I never said a word." 

"This seemed to shock her out of her tirade. She left the room. The nurse returned and gave me the shot. The nurse practitioner returned an hour later and asked me questions that I was no longer in any condition to answer--that was why I wanted the exam before the pain shot. She ordered some tests. We waited another hour and asked if we could leave. We were told we had to wait for the test results. My husband asked a total of five times if we could leave and each time he was given the same answer. Every time I came out to go to the bathroom the nurse practitioner and her staff stopped what they were doing, turned and glared at me. 

Finally, after four hours, a male doctor came in the room. He stood in the doorway, crossed his arms and said, "We are not giving you any more drugs." My husband was stunned. "We were told we were waiting for test results," he said. "The nurse said she thought my wife was having a reaction to the antibiotics from an earlier visit." The doctor continued to stare me down, refusing to look at my husband. "The tests take days, and we are not giving you any more drugs," he repeated. This time, my husband stood up. "We have been waiting for hours to leave," he said. "We are leaving now!" The doctor said he would get my papers to sign me out. We called a few days later to ask for the test results and we were told there were no tests." I asked to speak to someone to make a complaint. They sent a letter two months later claiming it never happened."

"The next week, one of my doctors from Texas finally located a doctor who was taking new patients and took my insurance. We explained my ongoing symptoms, the cough that was now months old, the night sweats, flu symptoms. He suggested menopause, allergies, I told him my doctor in Texas was very thorough and I was tested for all of these before leaving that state because of migraines. My husband then told the doctor what happened in the Er and asked for help finding those original tests. The doctor called a nurse in and she had them in her hands five minutes later. She had pulled them off the computer. 

The doctor told us he had spent an hour talking to a doctor at that same hospital earlier that day--one doctor out of thousands in that system--and he thought we "may have misjudged the situation." That doctor spent the next three appointments trying to psychoanalyze me every time I tried to discuss my symptoms. This went on for months. I finally picked up my purse without saying a word and left. He later wrote a report claiming we were arguing over medications--a blatant lie. We weren't arguing at all. He would talk so much when we came to see him--and I was always very careful to take my husband as a witness--that I often wondered if the doctor knew I was in the room!"      

My symptoms continued for the next 18 months. Sometimes they seemed to get better, sometimes they were worse. I was given antibiotics a few times and they made me so sick I was always in the ER for help. One doctor tested my blood and did an ultrasound, told me I had an enlarged bile duct, then she repeated the blood tests. We heard her talking in the hall about possible cancer. She referred me to a Gastroenterologist who did many tests, found lesions on various body organs, but nothing to confirm a cancer diagnosis. Another doctor also found lesions--a sign of Valley Fever. I was finally told about a disease called Valley Fever. That same night I had another reaction to an antibiotic. 


My husband begged the ER doctor for over an hour to test me for Valley Fever and he finally did. I tested low, but positive. I was told by one doctor that I have Valley Fever and by another that the disease had disseminated throughout my body. Another doctor became livid when I told her I was diagnosed with Valley Fever, shouting and throwing papers around her desk, angry that she could not find my tests, angry that I would suggest such a thing when I had not seen a pulmonary specialist. I did not say a word. I picked up my purse and left the room as I have learned to do whenever a doctor in New Mexico becomes violent--if you respond, they will refuse treatment, but they have the right to treat you in any way they please. This doctor makes certain that her report claiming I don't have Valley Fever is sent out whenever I see a doctor. I still have not received treatment for the Valley Fever. I'm still sick two years later." --Anonymous

Compassion: A Definition


According to Webster's Dictionary compassion is "a feeling of wanting to help someone who is sick, hungry, in trouble." The definition also states "a sympathetic consciousness of other's distress together with a desire to alleviate it." Most of us do not need an explanation or definition of compassion. It comes naturally to us. When we see someone suffering, our heart breaks for them and we do all we can to reach out to the suffering person and try to help. At my age, I have sadly learned that there are less people than I thought who truly understand compassion.

Through the years, in my various jobs and experiences with people, I have learned the Rule of Hypocrisy in Abuse and Bullying: If a person is bullied and abused and does not defend herself, people say she is weak, or enjoyed it, wanted it, asked for it. If that same woman does anything to defend or protect herself people say she is mean and aggressive, and deserved it, or asked for it. Once someone decided to harm you, there is nothing you can do to stop them. The target of the abuser must find a way to convince others to intervene in the situation, and even then it may not be enough to stop the abuse or prevent the abuser from harming others.

Two young refugees from Luxembourg with their pet rabbit in Surrey during 1942. Photo by Bryson Jack, Ministry of Information Photo Division Photographer, in public domain.

I have always believed that compassion and kindness should be both encouraged and taught in schools. If teachers are responsible for raising the future leaders of our country, then I want to know those future leaders will, as Websters states, want to help others who are sick, hungry, and in trouble, and have a desire to alleviate the distress of others. In my opinion, that should be included in the job description of politicians, teachers, and others.

Compassionate Care

"Others" includes medical personnel. I believe that a compassionate "bedside manner" should be required education for medical professionals. I recently read an article in the The International Journal of Person Centered Medicine: "Compassionate care enhancement: benefits and outcomes" by Stephen G. Post, PhD. According to Post, a review of his study showed that compassionate care was beneficial to patients with regard to wound healing, satisfaction and well-being. It also showed that compassionate care benefits physicians by lowering depression rates, burnout, and increasing more diligent care. Compassionate care benefits medical students as demonstrated by decreased complaints about abuse in clinical environments and team interactions. Therefore, compassionate care benefits the health care system's reputation as a whole.

Post clearly understands hospital settings, particularly emergency room settings where patients come when they are desperate and cannot receive the necessary care from their general practitioner or a community clinic. According to Post, "The care of a patient is both a science and an art. It is on the one hand the competent application of science; on the other hand it is the art of being attentively and fully present to the patient in a manner that facilitates well being, security, treatment adherence and healing. Compassionate care is the essence of this art."

Bullies and Medical Careers

Unfortunately, there is a segment of the population who find it impossible to show compassion. They are referred to as "bullies," but in a way this could be considered name-calling, which is a form of bullying. Bullies require re-education and training to teach them to communicate effectively with others in their community.

According to another study conducted at the University of Chicago using MRIs of the brains of bullies, it's possible that bullies cannot be re-educated. The study shows a "disruption in the natural empathetic response. In other words, in spite of the fact that most bullies spend their time calling other people "crazy," it's their brains that are wired differently. They actually derive pleasure from seeing others in pain.

So, what does this have to do with medical professionals? Plenty. According to John S. Murray, author of "Workplace Bullying in Nursing: A Problem That Can't be Ignored" in the Journal of the Academy of Medical-Surgical Nurses, bullying in nursing has become a "serious problem." Murray defines bullying by medical professionals as "verbal abuse, threats, humiliating or intimidating behaviors." He also explains that bullying behaviors create feelings of defenselessness in the victim and significantly demoralize his or her right to dignity."

So, if this is the result of bullying between nurses, imagine the result on patients when they are bullied by nurses and other medical professionals or hospital personnel. Imagine how a patient feels when they file a complaint, understanding that mistakes can happen, that even medical professionals can have a bad day, and all they want is to make sure another patient is not subjected to the same treatment, and instead they are told the event never occurred. The patient is helpless, suffering, in pain, seeks help at the only place we are taught in our society is a safe place to go when a person is in a potentially dangerous situation, and they are neglected, ignored, bullied, abused, then called a liar by administrators.

According to a 1990 study by Pediatric Physician Henry K. Silver, 46.6% of medical students were abused at some point during their education process and by the time they were seniors, 80.6% who chose to remain in that field of study reported bullying and abuse. This abuse was found to be heirarchical--doctor to nurse; nurse to patient.

According to Murray, nurses may bully for various reasons, not all of them heirarchical. For instance, they may bully each other and patients because they feel the need to control all aspects of their work environment. The perpetrator--doctor, nurse, or any medical professional--may have a personality flaw, such as psychopathic tendencies, or an exaggerated sense of self, therefore lacking the ability to feel remorse for their abusive treatment of others.

Bullying incidents also follow the same pattern with professionals as they do with children. There is a sterotype of a weak victim, the belief that the victim is inadequate and somehow deserves to be bullied, but growing evidence points to the fact that bullies often choose targets who make them feel inadequate and their actions are driven by jealousy or envy. In schools, doctors and nurses bully the highest performing students. In the workplace, they target the highest performing professionals, or patients who make them feel inferior or insecure.

Dangers to Patients

The Institute for Safe Medication Practices conducted a survey in 2004 and discovered that nearly half of health care personnel surveyed said they would keep silent rather than question medication orders from a difficult doctor due to workplace bullying. An additional 7% admitted that they were involved in a medication error in the past year and that bullying and intimidation was responsible. The study suggests a rise in 200,000 avoidable medical errors and consequential 200,000 avoidable deaths per year due to bullying.

What can be done?

This question will be addressed more fully in further posts, but the Institute for Safe Medication Practices also makes suggestions. They suggest that healthcare organizations create a "code of conduct and values. The code should encourage behaviors that safeguard team cohesion and staff morale, sense of self-worth, and safety." The ISMP also suggests a conflict resolution process, but these can be tricky if they involve one colleague judging another. They can also be completely ineffective. The ISMP suggests "a conflict resolution process that ensures effective communication, protects patients, and strictly enforces a zero tolerance policy for intimidation, regardless of the offender’s standing in the organization." Unfortunately, this journalist has found that most conflict resolution processes involve one nurse sitting down and talking to another or one doctor talking to another. It rarely, if ever, involves input from the patient, nurse, or person who was victimized during the bullying process.

Resources:

Sources:
  • "Bullies may enjoy seeing others in pain: Brain scans show disruptions in natural empathic response." UChicago New. The University of Chicago. Posted November 7, 2008. Accessed January 19, 2014.
  • Post, PhD. Stephen G. "Compassionate care enhancement: benefits and outcomes." The International Journal of Person Centered Medicine.
  • "Survey Shows Workplace Intimidation Adversely Affects Patient Safety." Institute for Safe Medication Processes. Press Release: March 31, 2004.

1 comment:

Anthro-Phobe said...

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