While rude, disruptive behavior by physicians on TV may be funny, when it happens in real-life it’s decidedly less amusing. And it’s time we stop tolerating and ignoring disrespectful behavior in the learning and clinical environment. Chair of the AAMC Board of Directors A. Lorris Betz, M.D., Ph.D., focused his address at the association’s annual meeting in Chicago on the difficult, but not impossible task of changing the culture of medicine.
Betz began his address by giving examples of not-so-funny behavior by physicians at the institution he led for 12 years as Senior Vice President for University of Utah Health Sciences. He then outlined statistics to show how deeply entrenched this behavior is not just at one institution but throughout medicine.
“You may argue that the offenders are a small minority. It’s just a few bad actors who give us all a bad name,” said Betz. “But when you look at the numbers, another story unfolds.” Nearly three-quarters of physicians who responded to a survey by the American College of Physician Executives reported seeing their colleagues behaving badly every month and more than 10 percent reported seeing it daily. Medical students are often at the receiving end of this bad behavior, with nearly 60 percent reporting having experienced some form of mistreatment during training.
Betz asserted that we need to stop thinking about disrespect as an isolated problem but rather systemic . . . embedded not only in how we train but also how we care for patients. “Programs that are focused on student mistreatment or the disruptive physician are directed at treating the symptom and not the disease,” said Betz. “Bad behavior is the symptom. A culture of disrespect is the disease.” And that disease not only results in humiliation, shame, and low self-esteem for medical students but also affects patient safety, the ability to work in teams, patient satisfaction, and malpractice claims. He challenged the audience to stop “stop treating just the symptoms” but rather “find a cure for the disease.” Let’s stop being defeatist about changing a deeply entrenched culture and begin to believe that change is not only vital,” said Betz. “It is possible.”
As proof, Betz outlined how the culture at University of Utah Health Care changed through an initiative called the Exceptional Patient Experience. Embarrassed by scathing patient letters, abysmal patient satisfaction surveys, and experiences that his wife had first-hand, he issued a system-wide mandate to provide an exceptional experience for every patient, every time, at every point of their care. “The goal was clear, but we left its execution to the individual departments and divisions.” Hospital clinic and staff immediately embraced the idea but physicians were a holdout. The breakthrough came when they begin creating scorecards for individual physicians and eventually shared their progress with the entire system. It became personal and competitive and physicians finally took note. Patient satisfaction scores skyrocketed from the 27th percentile to the 66th percentile, and Betz reported that patients were happier, clinic sessions ran more smoothly, and complimentary letters began replacing the embarrassing ones.
When Betz stepped down in 2011, his successor, Vivian S. Lee, M.D., Ph.D., M.B.A., embraced the initiative and pushed the level of transparency even further, becoming the first system to publish patient satisfaction scores online. Their physicians now enjoy top rankings when compared nationally for patient satisfaction.
Focusing on patient satisfaction didn’t weigh the system down in other areas, but rather improved performance, In two year, University of Utah Health Care jumped from 50th place to number one in quality, according to the University HealthSystem Consortium rankings and has stayed in the top 10 for the past five years. Costs are going down, and reporting of student mistreatment on the Graduation Questionnaire has declined.
Betz admits that changing culture is not for the faint of heart. “It takes courage.” He challenged the audience of physicians, academics, students, and leaders to “begin the work of breaking up this age-old and useless cycle. Individually and collectively, we need to act now. It’s a good business decision. It’s a good people decision. Moreover, it’s what our patients expect and deserve. It’s what our learners expect and deserve. And it creates the kind of environment that we all want to work in. Working together, I believe we can achieve it.”