Bullying in the Healthcare Setting
Organizations must reform their company culture to support patients.
Posted October 25, 2022 | Reviewed by Hara Estroff Marano
- Patients often experience medical bullying when they disagree or need more time with healthcare decision making.
- Informed consent is the practice of being informed about the risks versus benefits of a treatment plan.
- Providers are often involved in healthcare organizations that promote bullying behavior from the top down.
- If organizations change, providers change; patients then may experience more open-minded care.
There are growing concerns of mothers who have been threatened in the healthcare setting. They bring their children in for care, disagree with the treatment protocol, or require more time to consider their options. In response to the hesitation, the providers, instead of easing the patient's concerns, threaten the family with a phone call to child protective services.
Such a tactic bullies the person to be medically compliant while also suggesting they are being neglectful for not moving forward quickly with care. Sadly, this is not a new occurrence and one that I have seen many times throughout my practice.
All healthcare providers follow a code of ethics and must give the patient informed consent. Informed consent is defined as providing a person with information about the risks as well as the benefits of a treatment. Also, providers must be sensitive to cultural, religious, or philosophical beliefs that patients may have and that require additional attention.
Information must be provided to patients either orally or in written form. Patients can then reflect on the risks versus benefits of the treatment plan and weigh whether it aligns with their cultural, religious, or philosophical views. The U.S. does enumerate five competing statements of informed consent, such as public health emergencies, medical emergencies, incompetence, therapeutic privilege, or waiver from making decisions.
The practice of informed consent is grounded in ethical principles of respect for the person. International codes and human rights law act as a universal measure to respect each person's beliefs when it comes to their healthcare. The Nuremberg Code, Helsinki IV, and the Council of International Organizations of Medical Sciences provide ethical guidelines focused on complete disclosure to enable individuals to make freely informed decisions. In addition, the International Bill of Human Rights includes the right to autonomy.
When patients believe a provider is not respecting their right to informed consent, they can file a formal complaint. A recent study examining physicians who received formal complaints did indicate a change in the patient-doctor relationship. Physicians can learn how to deliver the information to the patient more effectively or they can develop defensive medical practices and trigger anxiety or other stress responses.
Disrespect exists in the healthcare culture. A study surveying medical staff found that more than half of the respondents reported experiencing disrespectful behaviors on the job. For example, 71% received negative comments about colleagues, 68% experienced a refusal to answer questions or return calls, 56% experienced constant nitpicking and fault-finding, 55% were reluctant to follow safety practices, 55% experienced impatience in questions, and 54% of the respondents experienced condescending language, demeaning comments, and insults.
The results show the continued acceptance of disrespectful healthcare behavior. This normalized behavior that providers and healthcare team members experience can quickly be passed down to patients. Many organizations need to address such behaviors. Widespread as such behaviors may be, reports may reflect an undercount as many individuals who engage in them may hold influential positions within organizations, discouraging reporting based on fear of retaliation.
The solution to this problem is to improve the healthcare culture to encourage acceptance of differing opinions and ideas. Science and medicine, in general, have lost a creative mind that explores possibilities instead of harsh mandates. One that encourages questions and free thinking. A scientific approach. This culture must be created from the top down while balancing regulations and liability.
Cultures must change so providers do not feel encouraged to bully their patients. A supportive, encouraging, and healthy healthcare culture may translate to patient care. It is vital that patients feel safe in the healthcare setting, to not only be able to ask questions but to take time to make decisions. It is human nature to pause when having to make a life-altering decision. It is healthy to weigh options. The more providers respect the decision-making time and process, the more compliance they may elicit from their patients.
Gostin LO. Informed Consent, Cultural Sensitivity, and Respect for Persons. JAMA. 1995;274(10):844–845. doi:10.1001/jama.1995.03530100084039
Grissinger M. (2017). Unresolved Disrespectful Behavior in Health Care: Practitioners Speak Up (Again)-Part 1. P & T : a peer-reviewed journal for formulary management, 42(1), 4–23.
Hanganu, B., & Ioan, B. G. (2022). The Personal and Professional Impact of Patients' Complaints on Doctors-A Qualitative Approach. International journal of environmental research and public health, 19(1), 562. https://doi.org/10.3390/ijerph19010562
Kumar N. K. (2013). Informed consent: Past and present. Perspectives in clinical research, 4(1), 21–25. https://doi.org/10.4103/2229-3485.106372