The attending physician just said what to the patient? Office of Graduate Medical Education Loyola University Medical Center Fall, 2016

Session Objectives Identify behaviors of health care teams which disrespect patients and colleagues Discuss ethically appropriate use of humor in health care Discuss the impact of witnessing or experiencing unprofessional team behaviors on team member moral distress List and utilize resources for trainees to address witnessing or experiencing unprofessional behavior Identify aspects and examples of professional behaviors and its effect on the healthcare interaction

Disclaimer Who says wrong things? We all say the wrong thing. Wrong can be Unprofessional Sarcastic Angry Disrespectful Light hearted Meant to diffuse tension Joking to “fit in”

What we know Professionalism lapses often result from a temporary mismatch between the individual’s knowledge, judgment, or skill and the complexity of the situation in which one finds themselves. Professionalism lapses are more common than we think. They occur in predictable circumstances. Individuals are stressed. Situations are charged. Controversy is present. There are AT LEAST 3 sides to every story. Side 1 Side 2 What actually happened

The Consequence of Silence Sometimes not saying something is wrong as well. Observing unprofessional interaction Overhearing snarky comments about other members of the healthcare team or other physicians Observing someone cutting corners E.g. ignoring isolation precautions “What we allow, we teach”

YouTube Clip Virginia Patient Under Anesthesia for Colonoscopy His Cell Phone Records the Conversations in the Room https://www.youtube.com/watch?v=Kar52idHgho

Gallows Humor Article Discussion

Discussion Turn to your peer and discuss: Group Discussion What are your initial thoughts about this situation? What would you do if you were the trainee in the room? Have you experienced or witnessed unprofessional behavior toward patients or yourselves? What is appropriate use of humor in medicine? What are your options to address situations of witnessed or experienced unprofessional behavior? Group Discussion

Discussion What is OK to say? Is this humor damaging to our sense of professionalism? Does this lead to calloused behaviors/ responses? What if what we said was heard by Patient Peers Superiors Press

Resources to Report Concerning Behaviors Peer to Peer/ Faculty Evaluations Program Director/ APDs GME office 7-4GME (74469) Anonymous reporting on Loyola GME Website www.loyolamedicine.org/gme Campus Ministry Academic Advisors Employee Assistance Program (EAP) 64129

Confidential Reporting Systems VOICE reporting system Patient Safety Event Reporting Anonymous system All reports involving a trainee are reviewed by the GME office All reports involving faculty are reviewed by the Chief of Staff office What can be reported? Near misses (safety) Inappropriate behaviors (work environment) Bad outcomes (root cause analysis) Flaws in the system (safety)

The Profession of Medicine Honor Privilege Self-Regulating Boards Resident Education Most physician problem behavior

Reality check We act professionally FAR MORE than we don’t. Acting professional occurs in large and small ways can be seen by what we do or don’t do can be seen by what we say or don’t say

Admirable Professionalism Name some specific instances in which you observed a resident or faculty demonstrating professional behavior. How did it effect the interaction? Could the situation have gone badly if handled differently? Have you seen an example of professionalism that has changed the way in which you approach complicated situations?

The Profession of Medicine What do we do everyday? We take care of the most vulnerable people at very emotionally charged times. These “people” are moms, dads, sons, daughters & friends. These people deserve the same dignity you would want given to your loved ones.

The Profession of Medicine The Challenge of Medicine A Calling Emotional at times Rewarding Self Regulating (to a point…) Once others have to step in to regulate, there’s usually a big problem.

Unprofessional Comments So, what do you do when it is you who says it? We all do it… What can you do to minimize the possibility it will be you?

Including our own. Always use this as the final slide in your presentation.