Doctors vs. Nurses: Communicate or Die

Some 200,000 patients are estimated to die each year because doctors dress down or intimidate nurses, nurses don't speak up, and hospital teams communicate badly, if at all. It's a drastic case of "Communicate or Die." What can be done to improve matters?

Already in 1984, researchers showed that on average, doctors interrupted eighteen seconds after patients began explaining their problems.

We have all been there: you walk into a doctor’s office, and the doctor asks, “What brings you here today?” You start to answer. Eighteen seconds later, the doctor interrupts you mid-sentence. The study found that fewer than two percent of patients got to finish their explanations.

When Dr. Wendy Levinson, vice chairwoman of the University of Toronto’s department of medicine, studied malpractice suits, she found that bad communication is a common theme. What often prompts people to sue their doctors “is the feeling that they were not listened to, that they didn’t have the doctor’s full attention.”

Problem physicians come in many guises, patients say: the arrogant or dismissive doctor; the impatient doctor with his hand on the doorknob; or the doctor who is callous and judgmental.

But doctor-patient communication is only part of the equation. What about the doctor-nurse relationship?

Theresa Brown, an oncology nurse at a Pittsburgh hospital, recounted in The New York Times how during one morning round, the whole medical stood in a patient's room, waiting for test results that turned out to be late. 

The patient, a friendly middle-aged man, took it in stride. He jokingly asked the doctor whom he should yell at. 

Turning and pointing at the patient's nurse, the doctor replied, "If you want to scream at anyone, scream at her."

The nurse being singled out and humiliated in front of her colleagues and the patient was of course Ms. Brown. "As we walked out of the patient's room," she recalled, "I asked the doctor if I could quote him in an article. 'Sure,' he answered. 'It's a time-honored tradition--blame the nurse whenever anything goes wrong.' I felt stunned and insulted."

Virtually every nurse has a similar story, "and most of us have several," Ms. Brown writes. A nurse she knows, attempting to clarify an order, was told, "When you have 'M.D.' after your name, then you can talk to me."

A doctor dismissed another nurse's complaint by simply saying, "I'm important."

It all sounds as if Dr. House of the medical drama "House" (see video) had all of a sudden stepped into the real world.

Worse, much of the bullying does not fit the stereotype of the surgeon throwing a temper tantrum in the operating room. It is passive, like ignoring pages or phone calls, subtle condescension, or sarcastic remarks. 

Such behavior can have a chilling effect on communication among the hospital staff. A 2004 survey by the Institute for Safe Medication found that workplace bullying posed a critical problem for patient safety: Rather than bring their questions about medication orders to a difficult doctor, almost half the health care personnel surveyed said they would rather keep silent. 

And 7 percent said that in the previous year they had been involved in a medication error in which intimidation was at least partly responsible.

The result: a rise in avoidable medical errors, the cause of perhaps 200,000 deaths each year.

Now do you still believe "Communicate or Die" is an overly dramatic a title for my book?

What do you think? Do you have your own story of witnessing doctor-nurse or doctor-patient interactions? And what can be done? I look forward to reading you on http://thomaszweifel.blogspot.com/.

P.S. This article is adapted from my book The Rabbi and the CEO: The Ten Commandments for 21st Century Leaders (co-authored with Rabbi Aaron L. Raskin and a Finalist for the National Jewish Book Award and the Foreword Book of the Year).