An important, yet often overlooked cause of medical errors is workplace bullying, a phenomenon that is tackled in a NY Times weekend op-ed by practicing nurse Theresa Brown.
Bullying, Brown explains, may take various forms, like a doctor dismissing a nurse with the remark, "I'm important." Even the most subtle hierarchical attitudes foster workplaces, where many employees view their coworkers as either not worthy of engagement or too demeaning to approach. To nurse Brown, the danger is not so much in bruised emotion, but in communication breakdowns, which "can make the difference between life and death."
Indeed, this environment fosters real and dangerous consequences for patients. According to a 2003 Institute for Safe Medication Practices survey of "more than 2,000 healthcare professionals," 7% of "respondents indicated that they were involved in a medication error during the past year in which intimidation clearly played a role." Approximately 200,000 deaths in the U.S. are due to preventable medical mistakes each year, according to the Hearst media corporation. Therefore, we can extrapolate roughly 14,000 deaths in the U.S. as due to workplace intimidation.
Brown's solution is a top-down approach, in which workplace conduct rules are treated with greater deference. She also advocates that physicians -- who she admits are mostly "kind, well-intentioned professionals," with whom she "rarely [has] a problem talking openly with" -- should institute change among their ranks by setting a tone for proper professional behavior.
Writing in his Medpagetoday blog, physician Kevin Pho, M.D., applauds Brown for exposing a sordid workplace reality. Unlike Brown, Pho would like to see bottom-up reform, starting with medical education, which he believes incubates adverse hierarchical inclinations.
But Dr. Pho cautions Brown's "inflammatory" criticisms of doctors, who she blames for the entire medical bullying climate. To Dr. Pho, Ms. Brown's one-sided account "only serves to drive a bigger wedge between doctors and nurses." Unintentionally proving his point, he highlights evidence of bullying in the nursing culture and complains that Ms. Brown unfairly uses her own NY Times media bullhorn to bully physicians.
Whether change occurs from the top or from the bottom, a more collegial environment in the professional medical world is certainly necessary if we hope to see greater workplace cooperation and fewer medical errors.
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