Check Up: Prescribing respect by doctors

Posted: September 11, 2012

Back in the mid-1990s, Lucian Leape, a Harvard pediatric surgeon, made a name for himself as one of the leaders of the movement to reduce medical errors.

His message was simple enough: Don't blame the doctors. Errors are a sign of a problem with the system.

The experts then looked for ways to reduce mistakes during procedures, like using checklists to ensure surgeons were operating on, say, the correct leg, and giving patients the drugs proven to produce the best results.

But getting established doctors to change proved harder than Leape expected, which is why he was at the Jefferson School of Population Health Friday talking to 85 medical and health graduate students.

Despite evidence that it reduces mortality, hundreds of surgeons still won't use checklists, Leape, 81, told members of the American Medical Student Association at the patient safety symposium.

Medical culture, he said, works against changing systems, so he's now advocating for culture change that begins in medical school. Doctors, he said, are trained to be individualistic, not team players. Their work culture allows some doctors to deride and humiliate medical students or nurses. Everyone is expected to work long hours in an environment rife with physical injuries. Patients are sometimes treated rudely.

Leape envisions a more respectful environment, and not just because it's more humane. People who are angry and mistreated are more likely to make mistakes and behave badly, he said. They're also less likely to talk to each other. Good communication is key to identifying problems and creating better systems.

"Disrespectful behavior is the root cause of the dysfunctional culture in medicine," said Leape, who is also chairman of the Lucian Leape Institute at the National Patient Safety Foundation.

Leape told the students to avoid following bad role models. "Model respect in your own behavior," he said. They should support others who are victimized, confront bad behavior when possible, "seek out champions and safe harbors" and join together to press administrators for change.

- Stacy Burling


Contact staff writer Stacey Burling at 215-854-4944 or sburling@phillynews.com.

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