I’ve always thought about respect as common decency, something we should do because it’s simply the right thing to do. In the medical world, we certainly need to strive for respectful behavior, especially given our historically rigid pecking order, our ingrained traditions of hierarchical bullying and, of course, a primary constituency — patients — who are often on uniquely vulnerable footing.
But then I stumbled across two articles in Academic Medicine that talked about respect as an issue of patient safety. The authors, a group of doctors and researchers at Harvard Medical School, outlined the myriad acts of disrespect that we’ve come to accept as a way of life in medicine, and showed how these can lead to a final pathway of harm to our patients.
This shift in perspective was a shock to the system. When we tolerate a culture of disrespect, we aren’t just being insensitive, or obtuse, or lazy, or enabling. We’re in fact violating the first commandment of medicine. How can we stand idly by when our casual acceptance of disrespect is causing the same harm to our patients as medication errors, surgical mistakes, handoff lapses, and missed lab results?
At one end of the spectrum are the examples of disrespectful behavior, like the volatile doctor everyone knows to steer clear of. Then there are the sadly common abuses of hierarchy — the doctor denigrating a nurse, the medical student treated like disposable goods.
Beyond these are the even more widespread passive types of disrespect, the behaviors that don’t ever get reported and are hardly noticed because they are so ingrained in the culture of medicine. Dismissive attitudes — toward other members of the medical team, toward students, toward administrators, toward patients — are as corrosive as outward manifestations of disrespect.