Last week’s Piece of My Mind, Solving the Silence, addressed the role of faculty in actively addressing patient disrespect to residents. Creating a safe learning and practice environment requires us to speak up, particularly in support to our residents and other learners. Being a resident does not mean you need to just put up with being disrespected. The authors of this Piece powerfully speak to the price of our silence when they state:
“Attending physicians must play a role in advocating for residents, and residents must feel confident that they have license to defend themselves. Each time these situations are met with silence, it sends several powerful messages: such sexual comments are acceptable, the problem is too big to solve, individual actions are inconsequential, and that overseeing physicians and the medical community at large do not value trainees enough to stop this harassment.”
Faculty: Please save this email to your Faculty Development folder on your email for future reference.
What would you do if you witness a resident being treated this way? Do you have a well-rehearsed phrase you can easily pull up and use when you witness a resident being disrespected by a patient? If not, please turn this into a learning opportunity and discuss it with your residents. One possible phrase is, “Dr. ________ is an important member of my team working hard to provide you with the best care possible. So I ask that we treat her the same way you would any other member of my team. Thank you.”
If you have a phrase you find effective, please share it with us.
Residents: What would you do if a patient treated you this way? What would you do if your attending witnessed this and said/did nothing about it? We need to speak up with each other about this. While we hope to be treated respectfully by others, sometimes we have to act in ways and be supported in ways that clearly state we deserve to be treated with respect. We recommend you discuss this with your attending and ask for their active support in the patient interaction. This is an opportunity for all of us to learn.
Here are some links to MCHS policies and resources that relate to this.
-MCHS Policy
Managing Patients with Difficult of Disruptive Behavior: Policy
-MCHS Policy
Managing Patients with Difficult or Disruptive Behavior: Process for Policy
-MCHS Professional Handbook
4.18 Difficult or Dangerous Patients
Difficult patients include those who are obnoxious, rude, profane, unreasonable, demanding and sometimes threatening, those who are noncompliant, especially with appointments, but also with recommendations and treatment, and those who are mentally ill including especially substance abusers who are drug-seeking, patients with various forms of somatoform disorder, personality disorders and organic brain syndromes with behavioral manifestations. In rare circumstances, these patients make serious threats or may become physically violent. It is the Clinic’s belief that medical science provides both a system as well as knowledge that should allow us to understand the problems these patients present to us as we attempt to provide them with the care they need and, in some cases, formulate a management strategy that can facilitate our interactions with them. It is the Clinic’s intention to actively seek out these patients, to develop useful problem formulations and management strategies that will allow us to provide these patients, like all other patients in our community, the medical care they need and deserve.
While the Clinic provides a spectrum of resources to assist individual clinicians in dealing with difficult patients, it is understood not all patients’ problems and clinicians are a good match for one another. If a workable physician/patient relationship cannot be developed or maintained, it is expected that clinicians will identify problems specifically that undermine the relationship, discuss them with the patient whenever practical and, if it is determined that the relationship is not longer functional, make arrangements for further care within the Clinic system. Generally, this can be accomplished within the department with the assistance of the Regional/Service Line Medical Director and Department Manager. Unilaterally severing a physician/patient relationship is unacceptable and, in some circumstances, may constitute legal abandonment. Therefore, if an orderly transfer of care cannot be accomplished within the department, the matter should be referred to the Risk Control program for consultation and assistance.
Individual practitioners and the Clinic are not obliged to continue relationships with patients who threaten violence, who are unmanageably abusive or disruptive, who are dishonest in their dealings with the Clinic, or are otherwise unwilling to reasonably contribute to a workable physician/patient relationship. In such cases, the Clinic may deny access for non-emergent care. Emergency care will never be denied. A request to deny access should be referred to the Risk Control program where a decision will be made considering the individual circumstance, the patient’s condition and the Clinic’s legal or contractual obligations, if any, to the patient.
-Also, the “patient behavior” incident form in RL Solutions has a selection for this type of situation. Log into the RL Solutions and look for the Patient Behavior Icon
Mike
Michael J. Schulein, Ph.D.
Resident Well-Being Committee chairperson
MCHS Division of Education