Although there are many exceptional physicians in the world who listen, ‘Doctor knows best, don’t challenge me’ still features prominently in medicine’s culture.
Even if patient safety is on the line, most medical students and residents won’t challenge their senior colleagues. This is because they think their opinion will be ignored, they’ve been warned by people they respect not to, they fear that doing so could damage their career, or they have friends whose jobs have been destroyed by such behavior.
In his book, Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out, Dr. Peter Pronovost, an intensive care physician at Johns Hopkins, discovered that in 90 per cent of serious, harmful patient safety events, at least one team member knew something was wrong but either didn’t say anything, or spoke up and got ignored.
We know that groups do better than expert individuals, yet we don’t get enough training about how to work this way in medical school. We spend countless hours looking at slides under microscopes to improve our individual knowledge, but very little time learning how to work as a team or how to resolve conflict.
Medicine’s culture of intimidation is slowly changing, however, because we’re starting to talk about it. This matters since it’s the first step towards making hospitals safer for patients, as well as constructive learning environments for doctors.