Author Topic: How we treat others and ourselves  (Read 6974 times)

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Offline dr-awale

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How we treat others and ourselves
« on: January 27, 2009, 09:24:39 PM »
By Nancy H. Nielsen, MD, PhD

Perhaps you saw this story that appeared this week in The New York Times about abusive and disruptive behavior by physicians. Although the examples detailed in the article are the exception rather than the rule, they are difficult to read.

We all know that most physicians do not act in this manner, and I agree with AMA Board of Trustees chair Joseph M. Heyman, MD, who is quoted in the story as saying, "Most people are trying to do the best job they can under a high-pressure situation." Still, disruptive behavior by physicians is an important subject because of how much it can jeopardize patient safety and quality of care.

Earlier this year the Joint Commission issued an alert about how disruptive behavior can undermine patient safety. Beginning Jan. 1, a new leadership standard from the Joint Commission will require hospital administrators to define such behavior and develop procedures to discipline inappropriate conduct by individuals working at all levels of an organization, including management, clinical and administrative staff members, licensed independent practitioners and governing body members.

Because that date is fast approaching, the AMA approved policy last month to convey to the Joint Commission that a one-year moratorium on the new standard is needed to provide a feasible time frame for medical staffs to bring their bylaws into compliance.

Whether or not the Joint Commission follows our recommendation, I would hope that bringing new attention to the issue of disruptive behavior will foster a free flow of communication between all members of a treatment team, which is essential to establishing a culture of safety. And it should underline the importance of health care workers being able to communicate with physicians without having reservations about how they'll be treated when they do.

A concern is that this new standard could serve as a vehicle for hospitals to shut down criticism by physicians or to remove doctors who speak out about quality and safety concerns. I don't believe that's the case. But to ensure that doesn't happen, we need a universal way of describing and identifying disruptive actions.

To help, the AMA is developing a code of conduct that will help medical staffs better define appropriate, inappropriate and disruptive behavior by physicians. This document, which will be part of updated model medical staff bylaws available through the AMA Organized Medical Staff Section in the coming weeks, will present a process for addressing such conduct and include a due process mechanism for physicians who are the subject of complaints. It will also reinforce AMA policy that specifically addresses the conduct of individual physicians.

As I noted earlier, I believe disruptive or poor behavior by physicians is infrequent and atypical. When it does occur, it could be an adverse reaction to pressure, or it might be triggered by something more serious, such as a health issue. That's why it's so important for us to pay attention to our own well-being.

A few weeks ago I spoke at Doctors' Health Matters-Finding the Balance, an international conference on doctors' health cosponsored by the AMA, the British Medical Association and the Canadian Medical Association. The conference served as a wonderful forum for physicians and researchers to present recent findings, innovative treatments and educational programs regarding doctors' health, and I learned a great deal about how physicians in other countries handle the many stresses of our profession. I strongly encourage you to take some time and view the presentations and panel discussions from the conference, which are available online.

The AMA has strong policy stating that physicians have a responsibility to maintain their own health and wellness. That's broadly construed as preventing or treating acute or chronic diseases, but it includes mental illness, disabilities and occupational stress. AMA policy also states that "physicians whose health or wellness is compromised should take measures to mitigate the problem, seek appropriate help as necessary and engage in an honest self-assessment of their ability to continue practicing." That's an important reminder for all of us.

Earlier this year the AMA added to that by resolving to support programs related to physician health and wellness, including those offered in conjunction with Federation of State Physician Health Programs. The AMA also offers a number of resources through the AMA Women Physicians Congress that can help all physicians and medical students maintain a healthy balance between their careers and their personal lives.

Physicians suffer the same illnesses, stresses and anxieties as our patients. If we do not care for ourselves, then we are not going to be nearly as helpful to those who depend on us.

Sometimes we close off or close down, without getting help or even talking about the problems we face, the losses we suffer and the unique career stresses such as medical liability charges or patient deaths.

Just remember the flight attendant on your last plane ride who recommended you to put oxygen on yourself before attempting to help others. That's an important metaphor for physicians-take good care of our own health so we can better care for others.




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