Balancing Rights and Responsibilities of Key Stakeholders in Addressing Reports of Disrespect Experienced by Patients
2022; Elsevier BV; Volume: 162; Issue: 5 Linguagem: Inglês
10.1016/j.chest.2022.06.001
ISSN1931-3543
AutoresWilliam O. Cooper, Gerald B. Hickson,
Tópico(s)Ethics in medical practice
ResumoProfessionalism in health care occurs in environments that present complex ethical dilemmas that demand ideal individual and team performance. Clinicians who behave unprofessionally toward patients and family members create a disproportionate share of risk for adverse patient outcomes and malpractice claims. However, when made aware, the vast majority will self-regulate. Several options exist for a clinician who observes or hears about an interaction between a colleague and a patient or family member that does not seem to be consistent with the organization's commitment to treat individuals with respect and dignity. Responses to unprofessional behavior need to recognize and balance the rights and responsibilities of key stakeholders, including patients, clinicians, coworkers, and the organization. In one approach, the clinician would speak directly with the colleague to make them aware of the event and encourage them to consider alternative approaches in future similar interactions. Alternatively, the clinician could ensure that the story is reported, reviewed, and shared through the organization's professional accountability program. Professional accountability programs must be supported by appropriate infrastructure elements. Sharing the observation helps to address the concerns and fears of patients and family members, offers a colleague the chance to reflect and reduce the likelihood of future unprofessional behavior, and seeks to fulfill one's individual responsibility to support colleagues as professionals, while striking the right balance of dignity, respect, and pursuit of trust for all key stakeholders. Professionalism in health care occurs in environments that present complex ethical dilemmas that demand ideal individual and team performance. Clinicians who behave unprofessionally toward patients and family members create a disproportionate share of risk for adverse patient outcomes and malpractice claims. However, when made aware, the vast majority will self-regulate. Several options exist for a clinician who observes or hears about an interaction between a colleague and a patient or family member that does not seem to be consistent with the organization's commitment to treat individuals with respect and dignity. Responses to unprofessional behavior need to recognize and balance the rights and responsibilities of key stakeholders, including patients, clinicians, coworkers, and the organization. In one approach, the clinician would speak directly with the colleague to make them aware of the event and encourage them to consider alternative approaches in future similar interactions. Alternatively, the clinician could ensure that the story is reported, reviewed, and shared through the organization's professional accountability program. Professional accountability programs must be supported by appropriate infrastructure elements. Sharing the observation helps to address the concerns and fears of patients and family members, offers a colleague the chance to reflect and reduce the likelihood of future unprofessional behavior, and seeks to fulfill one's individual responsibility to support colleagues as professionals, while striking the right balance of dignity, respect, and pursuit of trust for all key stakeholders. Navigating the challenging circumstances that arise while delivering complex health care requires consideration of the ethical issues that, if unaddressed, can on occasion make difficult situations even worse. Unprofessional behavior from clinicians toward patients or coworkers can lead to greater risk of complications and malpractice claims, particularly in stressful environments. For clinicians who encounter unprofessional behavior in a colleague, it is important to pause and recognize the underlying ethical principles in forming a plan for the most appropriate response, including the rights and responsibilities of all stakeholders. This article describes a case in which a clinician encounters a family member who describes an interaction with another clinician that seems to be inconsistent with the values of the profession. The article explores various elements to consider in finding a path forward to address the situation. You are an intensivist and have received handover from Dr Overnight, who just completed a 12-h shift. As you approach the bedside of one of your patients, the patient's spouse declares: "I am so relieved you are here. I've been frightened ALL night. Dr Overnight was coming in to see my husband and I overheard him talking to someone outside our room. Dr Overnight said, 'So we have another anti-vaxxer wasting one of our ECMO [extracorporeal membrane oxygenation] circuits again? I can't believe the ignorance—they're tying up equipment and placing all of us at risk.' Dr Overnight then marched into the room and immediately launched into a lecture about how we should have gotten my husband vaccinated. He never said hello, asked how I was doing, or anything about my husband. I am not sure if Dr Overnight might be happier if my husband died and freed up this bed. Will he be back tonight?" You pause and reflect on what you have heard and your professional values and duties. What are your professional and ethical responsibilities to the individuals and groups who are stakeholders in caring for your patient? The patient and the patient's family, you, Dr Overnight, other health care team members, your hospital along with its leaders, and society share a common interest in reliable, safe, and equitable care. What are potential approaches that address the fears of the patient's spouse, offer Dr Overnight a chance to reflect and reduce the likelihood of future unprofessional acts, and seek to fulfill your individual responsibility as a professional, while striking the right balance of dignity, respect, and promotion of trust for all stakeholders? Professionalism encompasses a set of underlying principles that guide the performance and interactions of individuals and groups who engage in a shared activity.1Egener B.E. Mason D.J. McDonald W.J. et al.The charter on professionalism for health care organizations.Acad Med. 2017; 92: 1091-1099Crossref PubMed Scopus (46) Google Scholar Professionalism in health care occurs in environments that present complex ethical dilemmas that demand ideal individual and team performance.2Carlasare L.E. Hickson G.B. Whose responsibility is it to address bullying in health care?.AMA J Ethics. 2021; 23: E931-E936Crossref PubMed Scopus (6) Google Scholar Professionals commit to self-regulation and group regulation and are committed to the best possible outcomes for their patients. Professionals model technical and cognitive competence, respect, clear communication, teamwork, availability, and a self-awareness of how their behaviors may impact colleagues and patients, including how, when, and where they share their personal feelings and beliefs.3Hickson G.B. Moore I.N. Pichert J.W. Benegas Jr., M. Balancing systems and individual accountability in a safety culture.in: Berman S. From the Front Office to the Front Line: Essential Issues for Healthcare Leaders. 2nd ed. Joint Commission Resources, Inc., 2012: 1-36Google Scholar Professionals also commit to upholding the shared clinical and ethical values of their organizations. If true, Dr Overnight's overheard comments and subsequent interactions with the family seem inconsistent with the values of the profession. A challenge in the moment is to address the spouse's fears.4Hayden A.C. Pichert J.W. Fawcett J. Moore I.N. Hickson G.B. Best practices for basic and advanced skills in health care service recovery: a case study of a re-admitted patient.Jt Comm J Qual Patient Saf. 2010; 36: 310-318Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar It is possible that the patient's spouse misheard or misinterpreted Dr Overnight's comments. That said, the important consideration is that the spouse perceived the comments to be directed toward her husband and is not unreasonably fearful, necessitating a thoughtful response. Failure to model respect for others in interactions with patients, families, and coworkers threatens outcomes of care.2Carlasare L.E. Hickson G.B. Whose responsibility is it to address bullying in health care?.AMA J Ethics. 2021; 23: E931-E936Crossref PubMed Scopus (6) Google Scholar,5Cooper W.O. Guillamondegui O. Hines O.J. et al.Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications.JAMA Surg. 2017; 152: 522-529Crossref PubMed Scopus (74) Google Scholar, 6Cooper W.O. Spain D.A. Guillamondegui O. et al.Association of coworker reports about unprofessional behavior by surgeons with surgical complications in their patients.JAMA Surg. 2019; 154: 828-834Crossref PubMed Scopus (80) Google Scholar, 7Cooper W.O. Hickson G.B. Guillamondegui O.D. et al.Professionalism of admitting and consulting services and trauma patient outcomes.Ann Surg. 2022; 275: 883-890Crossref PubMed Scopus (8) Google Scholar, 8Lagoo J. Berry W.R. Miller K. et al.Multisource evaluation of surgeon behavior is associated with malpractice claims.Ann Surg. 2019; 270: 84-90Crossref PubMed Scopus (23) Google Scholar Katz et al9Katz D. Blasius K. Isaak R. et al.Exposure to incivility hinders clinical performance in a simulated operative crisis.BMJ Qual Saf. 2019; 28: 750-757Crossref PubMed Scopus (75) Google Scholar illustrated how even mildly disrespectful behaviors directed toward others can affect surgical team member performance negatively, mediated through decreased vigilance, communication, and teamwork. Riskin et al10Riskin A. Erez A. Foulk T.A. et al.The impact of rudeness on medical team performance: a randomized trial.Pediatrics. 2015; 136: 487-495Crossref PubMed Scopus (196) Google Scholar demonstrated the deleterious impact of rude behaviors on teams speaking up and asking for help in a group simulation in neonatal ICUs, which resulted in reduced clinical performance. Other studies have described increased rates of patient complications and death and increased risk for malpractice claims for individuals and teams who model unprofessional behavior toward patients and coworkers.5Cooper W.O. Guillamondegui O. Hines O.J. et al.Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications.JAMA Surg. 2017; 152: 522-529Crossref PubMed Scopus (74) Google Scholar, 6Cooper W.O. Spain D.A. Guillamondegui O. et al.Association of coworker reports about unprofessional behavior by surgeons with surgical complications in their patients.JAMA Surg. 2019; 154: 828-834Crossref PubMed Scopus (80) Google Scholar, 7Cooper W.O. Hickson G.B. Guillamondegui O.D. et al.Professionalism of admitting and consulting services and trauma patient outcomes.Ann Surg. 2022; 275: 883-890Crossref PubMed Scopus (8) Google Scholar, 8Lagoo J. Berry W.R. Miller K. et al.Multisource evaluation of surgeon behavior is associated with malpractice claims.Ann Surg. 2019; 270: 84-90Crossref PubMed Scopus (23) Google Scholar,11Hickson G.B. Federspiel C.F. Pichert J.W. Miller C.S. Gauld-Jaeger J. Bost P. Patient complaints and malpractice risk.JAMA. 2002; 287: 2951-2957Crossref PubMed Scopus (441) Google Scholar In considering the ethical challenges that this case presents, several stakeholders have responsibilities and rights. Two primary stakeholders are the patient and spouse, whose ethical obligations include treating health care team members with respect and advocating for their own needs by speaking up or reporting when they have concerns.12American Medical Association Policy FinderViolence and abuse: bullying in the practice of medicine H-515.951. 2020. American Medical Association website.https://policysearch.ama-assn.org/policyfinder/detail/AMA%20Policy%20H-515.951?uri=%2FAMADoc%2FHOD.xml-H-515.951.xmlDate accessed: March 3, 2022Google Scholar,13Vanderbilt University Medical CenterPatient rights and responsibilities. 2020. Vanderbilt University Medical Center website.https://vanderbiltpolicytechcom/dotNet/documents/?docid=21196Date accessed: March 23, 2022Google Scholar Dr Overnight is a stakeholder with a professional obligation to treat patients with dignity and respect, even when patients make decisions for their own health that may differ from Dr Overnight's views. As a professional, Dr Overnight is expected to reflect and self-regulate when made aware of times when he may not meet those obligations. Dr Overnight has been observed criticizing a patient's health care decisions about COVID-19 vaccination in a public space, which was overheard by others. If true, Dr Overnight may not have considered fully the patient's right to autonomy and decision-making about their health. Of course, with respect to COVID-19 vaccination, the complexity of individual rights to decline vaccines and the potential impact on others creates a strong public health tension.14Giubilini A. Vaccination ethics.Br Med Bull. 2021; 137: 4-12Crossref PubMed Scopus (37) Google Scholar Although Dr Overnight may have slipped in this instance, Dr Overnight has rights to fair, respectful, and equitable feedback about performance, supported by an organization with the appropriate infrastructure to identify and address professionals with momentary professionalism lapses or model patterns of unprofessional behavior.15Pichert J.W. Moore I.N. Karrass J. et al.An intervention model that promotes accountability: peer messengers and patient/family complaints.Jt Comm J Qual Patient Saf. 2013; 39: 435-446Abstract Full Text Full Text PDF PubMed Google Scholar As the treating clinician and the point of contact in the moment for the spouse's fears, you have an obligation to balance the patient's right to be treated with respect and receive safe care with Dr Overnight's rights to respect and dignity in deciding how you will address the interaction. As a professional, you have a duty to engage in self-regulation and group regulation by either directly sharing the reported interaction with Dr Overnight or ensuring that the concerns are reported appropriately so that they can be addressed by the health system's patient relations team and the professionalism committee.3Hickson G.B. Moore I.N. Pichert J.W. Benegas Jr., M. Balancing systems and individual accountability in a safety culture.in: Berman S. From the Front Office to the Front Line: Essential Issues for Healthcare Leaders. 2nd ed. Joint Commission Resources, Inc., 2012: 1-36Google Scholar It also is important to consider your conscious and unconscious positive or negative biases toward Dr Overnight (ie, "I've worked with Dr Overnight for years and he would never say something like this." Or, "I've worked with Dr Overnight for years and I am not surprised. I'm going to report him."). Other members of the health care team have ethical responsibilities and the right to work in an environment where they are treated with dignity and respect. When Dr Overnight spoke to the colleague outside the room about your patient's vaccine status, that person may have had an opportunity to address the disrespectful language in the moment. However, hierarchy, prior behaviors by Dr Overnight, and an environment that may not fully support speaking up could create a situation in which it is difficult for the colleague to address the situation in the moment or report it, as appropriate.16Webb L.E. Dmochowski R.R. Moore I.N. et al.Using Coworker Observations to Promote Accountability for Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals.Jt Comm J Qual Patient Saf. 2016; 42: 149-164Abstract Full Text Full Text PDF PubMed Google Scholar The health system and its leaders have responsibilities to declare and uphold endorsed values and to ensure that the care delivered is safe and effective and that patients, family members, and clinicians are treated with fairness, respect, and equity.1Egener B.E. Mason D.J. McDonald W.J. et al.The charter on professionalism for health care organizations.Acad Med. 2017; 92: 1091-1099Crossref PubMed Scopus (46) Google Scholar,2Carlasare L.E. Hickson G.B. Whose responsibility is it to address bullying in health care?.AMA J Ethics. 2021; 23: E931-E936Crossref PubMed Scopus (6) Google Scholar The system also needs to ensure that patients' individual autonomy and privacy rights are considered in all interactions.13Vanderbilt University Medical CenterPatient rights and responsibilities. 2020. Vanderbilt University Medical Center website.https://vanderbiltpolicytechcom/dotNet/documents/?docid=21196Date accessed: March 23, 2022Google Scholar Giving voice to patients through a robust system that encourages them to share their concerns and identifies, addresses, and records patient complaints is an important part of a system's approach to safety.4Hayden A.C. Pichert J.W. Fawcett J. Moore I.N. Hickson G.B. Best practices for basic and advanced skills in health care service recovery: a case study of a re-admitted patient.Jt Comm J Qual Patient Saf. 2010; 36: 310-318Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar The health system and its leaders also have responsibilities to treat individual team members with fairness and equity,1Egener B.E. Mason D.J. McDonald W.J. et al.The charter on professionalism for health care organizations.Acad Med. 2017; 92: 1091-1099Crossref PubMed Scopus (46) Google Scholar with a balanced focus on the rights of patients, physicians such as Dr Overnight, and fellow team members. Leaders also should recognize that some individuals who model unprofessional behaviors may be struggling with underlying stressors or health conditions and should have access to wellbeing resources to assess and connect individuals with services as needed.17Welle D. Trockel M.T. Hamidi M.S. et al.Association of occupational distress and sleep-related impairment in physicians with unsolicited patient complaints.Mayo Clin Proc. 2020; 95: 719-726Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar,18Cooper W.O. Martinez W. Domenico H.J. et al.Unsolicited patient complaints identify physicians with evidence of neurocognitive disorders.Am J Geriatr Psychiatry. 2018; 26: 927-936Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar What is the best path forward that balances the rights and responsibilities of the key stakeholders? A response that accounts for the needs of only one stakeholder (including your own desire to avoid conflict or upset a colleague) without considering the needs of others may not be the best course of action. For example, considering only Dr Overnight's rights to declare his understanding of the truth whatever the circumstance without providing him feedback on how his actions may affect others may increase the risk of recurrent behaviors.5Cooper W.O. Guillamondegui O. Hines O.J. et al.Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications.JAMA Surg. 2017; 152: 522-529Crossref PubMed Scopus (74) Google Scholar,6Cooper W.O. Spain D.A. Guillamondegui O. et al.Association of coworker reports about unprofessional behavior by surgeons with surgical complications in their patients.JAMA Surg. 2019; 154: 828-834Crossref PubMed Scopus (80) Google Scholar,9Katz D. Blasius K. Isaak R. et al.Exposure to incivility hinders clinical performance in a simulated operative crisis.BMJ Qual Saf. 2019; 28: 750-757Crossref PubMed Scopus (75) Google Scholar,10Riskin A. Erez A. Foulk T.A. et al.The impact of rudeness on medical team performance: a randomized trial.Pediatrics. 2015; 136: 487-495Crossref PubMed Scopus (196) Google Scholar Ignoring the reported behavior also fails to fulfill your obligation to support the patient's and spouse's rights to receive health care in a supportive and respectful environment and for Dr Overnight's team members to perform at their highest levels.19Joint Commission on Accreditation of Healthcare Organizations. Sentinel events: behaviors that undermine a culture of safety. Accessed March 23, 2022. https://www.jointcommission.org/resources/patient-safety-topics/sentinel-event/sentinel-event-alert-newsletters/sentinel-event-alert-issue-40-behaviors-that-undermine-a-culture-of-safety/#.Yr8LMHbMKUkGoogle Scholar If you decide for whatever reason not to speak with Dr Overnight, you can still support your commitment to your organization and its clinical and ethical values by elevating the concerns to the health system. If the organization engages only when it is necessary to pursue disciplinary action with Dr Overnight when numerous unaddressed events escalate to make the situation untenable, it seems inconsistent with your collective pursuit of professionalism and equity. Within a safety culture, team members feel psychologically safe to speak up or report when they have concerns.3Hickson G.B. Moore I.N. Pichert J.W. Benegas Jr., M. Balancing systems and individual accountability in a safety culture.in: Berman S. From the Front Office to the Front Line: Essential Issues for Healthcare Leaders. 2nd ed. Joint Commission Resources, Inc., 2012: 1-36Google Scholar In this case, several individuals might speak directly to Dr Overnight about the spouse's concerns, including the colleague who was reported by the spouse to be present when the statements were made, another person who overheard the exchange, or you. One model for sharing professionalism concerns is a so-called cup of coffee for single events as a part of a tiered intervention model supporting professional accountability.20Hickson G.B. Pichert J.W. Webb L.E. Gabbe S.G. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors.Acad Med. 2007; 82: 1040-1048Crossref PubMed Scopus (232) Google Scholar Finding a 2- to 3-min window to speak privately with Dr Overnight soon after you are made aware of the event would allow you could share the spouse's story in a respectful, nonjudgmental way. In doing so, you balance your empathy for Dr Overnight's stresses with your shared commitment to the system's professional values. The cup of coffee conversation could include phrases such as: "Dr Overnight, I want to thank you for the hard work you put in for our patients. I know things have been stressful recently and I understand your passion for preventing illness. I wanted to share a story a patient's spouse told me after I received handover today. The spouse shared that she thought she overheard you criticizing patients who choose not to be vaccinated and perceived that you lectured them about their views. I recognize that patients and family members may mishear or misinterpret on occasion, and that often a story has two (or more) sides." As you pause to give Dr Overnight the chance to respond, Dr Overnight may push back, from criticizing the patient and family as being difficult, to denying that he made the statements, to moving the conversation to a different topic such as the efficacy of vaccines. You could acknowledge Dr Overnight's concerns and close with something like, "Thanks for talking with me. Our ability to speak directly with each other is important, particularly in stressful times like these. The reason I wanted to share with you is that we both know that sometimes things come off differently than intended. If it was indeed a misunderstanding, certainly opportunities exist to ensure that our patients feel that we are doing our best for them regardless of the circumstances. I hope that if similar circumstances arise in the future, you might consider whether alternative ways exist to share your thoughts with colleagues and with patients and their families." Being respectful to allow Dr Overnight to share his side of the story and closing with confidence that Dr Overnight will respond in thoughtful ways in the future as a valuable member of the team is part of a respectful approach to professional accountability. Studies have shown that 95% of individuals who receive feedback about individual patient complaints do not go on to develop patterns of unprofessional behavior toward patients.15Pichert J.W. Moore I.N. Karrass J. et al.An intervention model that promotes accountability: peer messengers and patient/family complaints.Jt Comm J Qual Patient Saf. 2013; 39: 435-446Abstract Full Text Full Text PDF PubMed Google Scholar If circumstances do not permit you to address Dr Overnight directly, you could give the spouse information about how to engage with the system's office of patient relations. The office of patient relations has team members trained in listening, conducting service recovery (hearing the concern and working to make things right), and recording the information in a central database to help to identify trends and professionals who may be struggling.4Hayden A.C. Pichert J.W. Fawcett J. Moore I.N. Hickson G.B. Best practices for basic and advanced skills in health care service recovery: a case study of a re-admitted patient.Jt Comm J Qual Patient Saf. 2010; 36: 310-318Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Because your organization is committed to professional responsibility, individual patient complaints are shared when they are received, or as in this case, individual peers address them in the moment.15Pichert J.W. Moore I.N. Karrass J. et al.An intervention model that promotes accountability: peer messengers and patient/family complaints.Jt Comm J Qual Patient Saf. 2013; 39: 435-446Abstract Full Text Full Text PDF PubMed Google Scholar These approaches support the system's ethical duties to treat patients with respect and dignity and proactively to address elements in the care environment that threaten team performance and the delivery of safe and effective care.2Carlasare L.E. Hickson G.B. Whose responsibility is it to address bullying in health care?.AMA J Ethics. 2021; 23: E931-E936Crossref PubMed Scopus (6) Google Scholar Delivering cup of coffee conversations and other interventions effectively requires an intentional approach to developing and sustaining the right infrastructure.3Hickson G.B. Moore I.N. Pichert J.W. Benegas Jr., M. Balancing systems and individual accountability in a safety culture.in: Berman S. From the Front Office to the Front Line: Essential Issues for Healthcare Leaders. 2nd ed. Joint Commission Resources, Inc., 2012: 1-36Google Scholar,16Webb L.E. Dmochowski R.R. Moore I.N. et al.Using Coworker Observations to Promote Accountability for Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals.Jt Comm J Qual Patient Saf. 2016; 42: 149-164Abstract Full Text Full Text PDF PubMed Google Scholar,20Hickson G.B. Pichert J.W. Webb L.E. Gabbe S.G. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors.Acad Med. 2007; 82: 1040-1048Crossref PubMed Scopus (232) Google Scholar, 21Talbot T.R. Johnson J.G. Fergus C. et al.Sustained improvement in hand hygiene adherence: utilizing shared accountability and financial incentives.Infect Control Hosp Epidemiol. 2013; 34: 1129-1136Crossref PubMed Scopus (58) Google Scholar, 22Hickson G, Cooper WO. Pursuing professionalism (but not without an infrastructure). In: Medical Professionalism Best Practices: Addressing Burnout in Our Profession. 2020:81-98. Alpha Omega Alpha Honor Medical Society website. Accessed February 9, 2022. https://www.alphaomegaalpha.org/wp-content/uploads/2021/10/2015MedicalProfessionalism.pdfGoogle Scholar The infrastructure includes leaders committed to model professionalism and to hold all team members accountable regardless of their status. Another important infrastructure element is a tiered intervention model to guide how individual professionalism concerns and apparent patterns are shared with professionals.20Hickson G.B. Pichert J.W. Webb L.E. Gabbe S.G. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors.Acad Med. 2007; 82: 1040-1048Crossref PubMed Scopus (232) Google Scholar Peers are trained on ways to share professionalism data in a respectful, nonjudgmental manner. A team to implement the program includes a champion to lead the effort, supported by a dedicated group of individuals who carry out the work. In a robust professionalism program, organizational processes align with the effort, including policies and procedures and resources to support individuals who may be identified as struggling from burnout or other challenges.17Welle D. Trockel M.T. Hamidi M.S. et al.Association of occupational distress and sleep-related impairment in physicians with unsolicited patient complaints.Mayo Clin Proc. 2020; 95: 719-726Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar,18Cooper W.O. Martinez W. Domenico H.J. et al.Unsolicited patient complaints identify physicians with evidence of neurocognitive disorders.Am J Geriatr Psychiatry. 2018; 26: 927-936Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar Finally, the health system commits to regular review of data to identify patterns or themes that may necessitate further action. You return and speak with the spouse, addressing the concerns and offering information about why and how to share their concern with the system's office of patient relations. The spouse does share the complaint with the office of patient relations, and a regular audit of patient complaint data by system leadership reveals that Dr Overnight has been associated with several unsolicited patient complaints recently and is associated with an apparent pattern of unprofessional behaviors toward patients.20Hickson G.B. Pichert J.W. Webb L.E. Gabbe S.G. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors.Acad Med. 2007; 82: 1040-1048Crossref PubMed Scopus (232) Google Scholar Under the health system's professionalism policy, a peer messenger is dispatched to deliver an awareness intervention with local and national comparative data.15Pichert J.W. Moore I.N. Karrass J. et al.An intervention model that promotes accountability: peer messengers and patient/family complaints.Jt Comm J Qual Patient Saf. 2013; 39: 435-446Abstract Full Text Full Text PDF PubMed Google Scholar In the conversation, Dr Overnight discloses recent sleep disturbance, disillusionment, and detachment from patients and coworkers.17Welle D. Trockel M.T. Hamidi M.S. et al.Association of occupational distress and sleep-related impairment in physicians with unsolicited patient complaints.Mayo Clin Proc. 2020; 95: 719-726Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar The peer messenger recognizes their inability to diagnose a condition in this circumstance but does encourage Dr Overnight to take advantage of the health system's confidential and robust programs for individual and team wellness based on the recent sharp uptick in complaints and his comments during the awareness conversation. Dr Overnight seems to be hesitant to engage at first but ultimately seeks support from a professional and identifies ways to cope with stress and burnout in the moment, reinforcing the importance of you fulfilling your professional duties to your colleague. Financial/nonfinancial disclosures: None declared.
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