Ever wonder if your doctor is laughing at you?
Story Highlights
Survey: 17 percent of doctors had made fun of a patient with their colleagues
Laughter at a patient's expense could compromise care, expert says
Poor behavior ratings early in career mean greater risk of disciplinary action later
By Theresa Tamkins
You're sick, in the hospital, or maybe even undergoing surgery. The last thing you want to contemplate is the thought that your doctor might be making fun of your toe rings while you're anesthetized.
Hospitals want to make sure that more seasoned doctors don't promote or further unprofessional behavior.
But does it happen? Yes. According to a survey of doctors starting a residency in internal medicine, 17 percent had -- along with their colleagues--made fun of a patient, sometimes when the patient was under.
Egad. Is nothing sacred? The good news, though, is that 94% of the 110 medical interns who took the anonymous survey realized that such behavior was inappropriate, according to a research letter published in the Journal of the American Medical Association. That means that only seven doctors in the survey thought that type of behavior was A-OK.
I guess it's not that surprising, given the behavior of our on-air favorites. From "Grey's Anatomy" to "House," the overwhelming warts-and-all portrait seems to be this: Doctors are human. They fall in love, they get angry, and they like a good chuckle -- sometimes at the patient's expense.
Is it so surprising that some of those bad on-air behaviors might occur in real life too?
Story Highlights
Survey: 17 percent of doctors had made fun of a patient with their colleagues
Laughter at a patient's expense could compromise care, expert says
Poor behavior ratings early in career mean greater risk of disciplinary action later
By Theresa Tamkins
You're sick, in the hospital, or maybe even undergoing surgery. The last thing you want to contemplate is the thought that your doctor might be making fun of your toe rings while you're anesthetized.
Hospitals want to make sure that more seasoned doctors don't promote or further unprofessional behavior.
But does it happen? Yes. According to a survey of doctors starting a residency in internal medicine, 17 percent had -- along with their colleagues--made fun of a patient, sometimes when the patient was under.
Egad. Is nothing sacred? The good news, though, is that 94% of the 110 medical interns who took the anonymous survey realized that such behavior was inappropriate, according to a research letter published in the Journal of the American Medical Association. That means that only seven doctors in the survey thought that type of behavior was A-OK.
I guess it's not that surprising, given the behavior of our on-air favorites. From "Grey's Anatomy" to "House," the overwhelming warts-and-all portrait seems to be this: Doctors are human. They fall in love, they get angry, and they like a good chuckle -- sometimes at the patient's expense.
Is it so surprising that some of those bad on-air behaviors might occur in real life too?
Is unprofessional behavior more common than in the past?
Television shows from yesteryear, such as "Marcus Welby, M.D." and "Dr. Kildare," presented doctors as somber and ultraprofessional, but that doesn't mean that unprofessional behavior is a new problem, says study author Vineet Arora, M.D., an assistant dean at the Pritzker School of Medicine at the University of Chicago.
"Those shows projected a much more professional image," she tells me, but "to say that this is a new phenomenon would not be correct."
Learning respect and discretionare part of the so-called hidden curriculum -- all of the things doctors learn on-the-job that don't have to do with diagnosing and treating diseases.
Hospitals want to make sure that more seasoned doctors don't promote or perpetuate unprofessional behavior and that newly minted M.D.s -- like those surveyed -- learn what is appropriate and inappropriate by the time they finish their residency, the training period after medical school.
While the teaching hospitals aren't trying to drain all the humor out of the residency experience, they want to teach doctors where to draw the line. "I do think there are examples of really good-natured humor that is therapeutic, but not at someone's expense," she says.
And laughter at a patient's expense could compromise care, says Dr. Arora.
"What if you were a patient and someone made fun of you behind your back?" she says. "You trust somebody to care for you and you would wonder about their ability to be objective and truly care for you."
Dr. Arora couldn't say whether the behavior of TV doctors -- such as Dr. House -- influences real-life doctors in any way. "That's an interesting question," she says. But TV programs do influence the public's image of doctors.
"Certainly media portrayal of physicians definitely has an impact on the public perception of physicians," she says.
Burnout may contribute to unprofessional behavior
Dr. Arora suspects that sleep deprivation and burnout are part of the problem. Doctors who behave unprofessionally, she explains, might have troubles of their own.
"There's a lot of good data to suggest that people who are sleep-deprived in these settings do have more staff conflicts and burnouts and could possibly even further exacerbate unprofessional behavior," she says.
Television shows from yesteryear, such as "Marcus Welby, M.D." and "Dr. Kildare," presented doctors as somber and ultraprofessional, but that doesn't mean that unprofessional behavior is a new problem, says study author Vineet Arora, M.D., an assistant dean at the Pritzker School of Medicine at the University of Chicago.
"Those shows projected a much more professional image," she tells me, but "to say that this is a new phenomenon would not be correct."
Learning respect and discretionare part of the so-called hidden curriculum -- all of the things doctors learn on-the-job that don't have to do with diagnosing and treating diseases.
Hospitals want to make sure that more seasoned doctors don't promote or perpetuate unprofessional behavior and that newly minted M.D.s -- like those surveyed -- learn what is appropriate and inappropriate by the time they finish their residency, the training period after medical school.
While the teaching hospitals aren't trying to drain all the humor out of the residency experience, they want to teach doctors where to draw the line. "I do think there are examples of really good-natured humor that is therapeutic, but not at someone's expense," she says.
And laughter at a patient's expense could compromise care, says Dr. Arora.
"What if you were a patient and someone made fun of you behind your back?" she says. "You trust somebody to care for you and you would wonder about their ability to be objective and truly care for you."
Dr. Arora couldn't say whether the behavior of TV doctors -- such as Dr. House -- influences real-life doctors in any way. "That's an interesting question," she says. But TV programs do influence the public's image of doctors.
"Certainly media portrayal of physicians definitely has an impact on the public perception of physicians," she says.
Burnout may contribute to unprofessional behavior
Dr. Arora suspects that sleep deprivation and burnout are part of the problem. Doctors who behave unprofessionally, she explains, might have troubles of their own.
"There's a lot of good data to suggest that people who are sleep-deprived in these settings do have more staff conflicts and burnouts and could possibly even further exacerbate unprofessional behavior," she says.
And there are more serious behavioral problems -- aside from laughing at patients.
The survey included questions about behavior that is frowned upon, such as attending a pharmaceutical-sponsored dinner or social event (69%), as well as behaviors that are considered egregious, including falsifying patient records (13%), and reporting patient test results as "normal" when unsure of the true results (10%).
"Those are examples that would compromise patient safety," Dr. Arora says.
An unprofessional demeanor in residency could spell trouble for your entire career, she adds. Research has shown that those with poor ratings on professional behavior early in their careers are at greater risk of disciplinary action later on.
The survey included questions about behavior that is frowned upon, such as attending a pharmaceutical-sponsored dinner or social event (69%), as well as behaviors that are considered egregious, including falsifying patient records (13%), and reporting patient test results as "normal" when unsure of the true results (10%).
"Those are examples that would compromise patient safety," Dr. Arora says.
An unprofessional demeanor in residency could spell trouble for your entire career, she adds. Research has shown that those with poor ratings on professional behavior early in their careers are at greater risk of disciplinary action later on.
* * *
Doctors making fun of them is a common complaint among patients with invisible illnesses. I've been laughed at for thinking there was something physically wrong; medical records have been falsified to say that I have a long history of depression and taking anti-depressants (even though no one noted prescribing them for me in my prior years of care at that medical group!); and any abnormal test result was simply excised from the list in the typed medical records (in hopes that no one would take the trouble to read the lab reports to see that there were, in fact, indications that there was something physically wrong).
As time went on, more astute (and caring) doctors actually listened to my symptoms and repeatedly diagnosed me with an invisible illness that would cause those symptoms. And the doctors who laughed at me ignored the specialists' diagnoses in order to say that I was just lazy or crazy.
Some day, there will be a definitive test for CFS and fibromyalgia, and when I get the positive results on those tests, I intend to have the lab report blown up to poster size and pasted to those doctors' office doors as a reminder that, as Dr. Starlanyl says, "if all tests are normal, it may mean that the proper tests have not yet been done."
When a physically active person comes to you and complains that she can only walk a short distance, it deserves compassion and investigation, not brushing off with the notion that she's just lazy or crazy, and laughing at her for thinking that she can get disability benefits just because she says she doesn't feel well. There "was no need to do a test" to prove that I got exhausted in minutes; until someone else finally sent me for a treadmill test and the doctor doing that test noted all the things that I'd been reporting for years, and having doctors tell me were a figment of my imagination so they wouldn't have to deal with the fact that this healthy-looking woman was seriously disabled.
Too many doctors over the years have refused to do too many tests, yet when I finally got the requested tests, they were positive. I was told for nearly 25 years that I could not have asthma because I don't make wheezing sounds ... till a doctor saw me actually gasping for breath 15 minutes after running half a block to catch a bus and concurred with me that this sure looked like asthma to her, there was no other reasonable explanation. The other doctors never asked me to prove it, just laughed and said "no way."
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