“Of may fear asking questions or providing vital information

“Of
course, you can’t hang a definitive score on a physician’s conduct as if it
were a clear-cut metric. Still, it can be assessed, and valuable feedback can
be provided to improve medical practice. It’s not easy, but it’s possible.”, as
stated by (Collier 2012). You may wonder why disrespectful behaviour persists
in healthcare. Healthcare organizations have fueled the issue for years by
neglecting to deal with it and in doing so have encouraged the acceptance of
such behaviours (Zimmerman 2011). People tend to refrain from reporting
incidences of poor behaviour, which can occur daily, due to fears and stigma
associated with whistle blowing (Grissinger 2017). In a profession such as medicine, where your
work is largely related to and carried out in close proximity to patients and
other members of the public, communication is a core component of the job and it
is essential to comport yourself properly at all times. It is important to
maintain a professional attitude towards one’s patients and one’s colleagues and
always conduct yourself accordingly. Clinicians, whom are in direct contact
with patients must do their upmost to help their patients without putting them
under any undue stress, anxiety or fear. If clinicians operate in a
disrespectful or even distant way, patients will be discouraged from engaging
with the clinician and may fear asking questions or providing vital information
regarding their ailment, which could lead to confusion and mistreatment in the
long run (Grissinger 2017). This will ultimately come to the detriment of the
patient and lead to an impediment in their recovery. Colleagues must also do
their best to maintain a healthy relationship with each other and refrain from
disrespectful or unacceptable behaviour of any kind. Conducting one’s self in a disrespectful
manner will hinder collaboration and communication between co-workers, lowers
the mood of a workplace, creates a hostile working environment, encourages some
people to refrain from attending work and can inevitably cause harm to the patient.
People at the receiving end of disrespectful behaviour will have feelings of
self-doubt, anxiety, fear, marginalization and many more serious inhibitions
that will diminish a person’s ability to make sound judgements and operate in a
safe and efficient manner (Grissinger 2017). Tensions can arise between people
working in close collaboration such as nurses and physicians or people from
different nationalities, due to conflicting communication styles and it is
important to maintain a cool head in situations like this or the workplace
could potentially grow to become hostile and inefficient. It is essential to be
wary of any behaviour that may be deemed unacceptable around both patients and
colleagues alike to ensure a comfortable and safe atmosphere for all.

 

Jesse
Gelsinger, an 18-year-old student with a mild genetic disorder, received
experimental treatment for a mild genetic disorder in September 1999. He died
within four days of having taken part in a phase 1 gene therapy trial. His
unfortunate death was said to have been caused by an abnormal reaction to the
experimental treatment. In the subsequent court hearing, it transpired that
information relating to the treatment had been withheld from Jesse prior to
treatment. Clinicians had neglected to inform Jesse about deaths associated
with liver injury in animal subjects prior to his treatment and material about
this had even been removed from his information sheets. According to Jesse’s
father, they had been lead to believe that the treatment was entirely
successful. In actual fact, none of the previous patients had experienced any
improvement with the drug. Interestingly, the main investigator had $13 million
invested in Genovo, the firm supplying this new experimental drug. The host
institution also had financial tie ins with the biotechnology firm, Genovo.
(Cregan 2001). “I have read that my son’s death has been called by one the
great leaders in this field as a pothole on the way to gene therapy. His death
was no tragedy. It was an avoidable tragedy from which I will never fully
recover”, (Judith A. Cregan). You can see here how a series of conscious,
unacceptable decisions have led to the death of a patient and the harm and
sense of loss have left a permanent reminder on those closest to Jesse. The
bereavement caused by the loss of this boy to his family could have easily been
avoided. This is quite an extreme case of unacceptable behaviour, but it is
still evident how poor behaviour on behalf of all those involved is completely
unacceptable and has greater ramifications beyond what they might have foreseen
in the moment. It is important to keep in mind the perspectives of those around
you and how one’s conduct might affect either your colleague’s ability to work
as efficiently and effectively as possible with you, or patients’ well-being
and trust. I also think it’s worth noting how the offending parties were well invested
in this new drug and were working hard to promote and push this drug. I believe
that it’s very bad practice to have such a biased situation transpire and
obviously very unfair and unjust for any patients exposed to such promotions.

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In
Aberdeen Hospital in Scotland in 2014, allegations were made against a series
of senior doctors working at the institution after serious failures were
brought to light regarding aspects of management, leadership, governance and
clinical care (NHS Scotland 2014). Issues relating to the behaviour of certain
individuals were highlighted such as efforts to undermine management,
threatening of colleagues, exclusion, bullying and the belief that certain
hospital policies did not apply to them. Conflict between colleagues was
reportedly exposed to patients and certain doctors even displayed negligence in
their work by not spending enough time in the wards. According to a review done
by the Royal College of Surgeons of England in 2014 it found that a
“significant number of the surgeons working within general surgery had
exhibited unprofessional, offensive and unacceptable behaviour” (Royal College
of Surgeons of England 2014). This review acknowledged that the treatment of
patients  in this institution was in line
with that of other health care centres in the area, but recognised that the
lack of professionalism and poor behaviour exhibited by certain individuals
likely compromised the level of care that the patients received. In any
hospital or general practice, the patient’s care should be of upmost importance
and the overlying priority. In Aberdeen Hospital it is clear that this core
principal is being disrupted by the activities of certain people.

 

It has
always apparent that physicians have been somewhat reluctant to report
colleagues due to a sense of camaraderie, fear of retaliation and
self-preservation (Hodges, Tak, Curlin, Yoon 2016). In America, professional
conduct is an integral part of the successful functioning of any health care
centre (Wynia 2008). In order for the health care system to proceed,
self-regulation is required to ensure individuals behave appropriately in their
workplace. This in part, is reliant on the readiness of physicians to be
individually responsible for each other (Wynia 2010). In a study carried out by
DesRoches, the majority of physicians were in agreement that there is an
obligation to report colleagues acting inappropriately, but only two thirds
were actually willing to go about reporting fellow co-workers (DesRoches,
Rao, Fromson, Birnbaum, Lezzoni, Vogeli 2010). It is imperative that physicians
overcome fears of whistleblowing if improvements are to be expected. In
relation to the example previously given regarding Aberdeen Hospital, the first
step in helping to improve a colleague’s behaviour must be to report them so
that the appropriate steps can be taken to ensure an improvement in their
behaviour. In terms of mentoring a colleague, I think it would be important to
outline to them what kinds of behaviour are acceptable in their respective
environments and advise them to imagine themselves in the perspectives of the
recipients’ of their behaviour and try to understand how certain actions might
seem unacceptable. It is essential that the colleague with poor behaviour
understands how their attitude may be improper in certain scenarios in order to
ensure that they make any sort of improvement in their comportment.

 

 

 

 

 

 

 

 

 

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