Researchers: Hospitals vulnerable to 'bystander effect'
Published 9:04 pm, Sunday, January 6, 2013
The murder of 28-year-old Catherine "Kitty" Genovese in 1964 remains an American horror story to this day, largely because of the circumstances surrounding the Queens, N.Y., woman's death. Genovese was stabbed on her way back from work to her apartment. Though nearly 40 people reportedly either witnessed the attack or heard Genovese's calls for help, they did nothing to intervene.
The phenomenon of standing idly by in the face of tragedy while assuming someone else will take action is often called the "bystander effect."
Distressingly, a pair of doctors affiliated with the Yale University School of Medicine said a similar dynamic can also exist in the medical community, where large teams of physicians are often assigned to one patient.
With so many hands involved in a case, it can be hard to determine who is supposed to be doing what, said Dr. Jason Lott, a post-doctoral fellow in dermatology and internal medicine at Yale, and Dr. Robert Stavert, a dermatology resident.
"Everyone assumes the mantle of responsibility rests elsewhere," Lott said. "We've been talking to our colleagues at other institutions about this, and it's something they see quite frequently."
In a piece on the phenomenon, the doctors cite a recent case at Yale-New Haven Hospital, where they were among nearly 40 doctors assigned to one 32-year-old man who had multiple organ failure and accompanying skin problems.
Due to the size of the team and the complicated nature of the case, confusion soon reigned.
"None of us were certain what was wrong with him and therefore each of us continued to wait for someone else to do something," Lott and Stavert wrote in their article.
Eventually, action was taken and the patient recovered. But the incident got the doctors thinking about the potential dangers of situations like that. The article, among other things, calls for improved communication and coordination of care among doctors in large teams. Stavert said the article's intent isn't to point fingers, but to call attention to the larger "bystander" issue.
"I don't think this is a particularly unusual case," he said. "I think this case illustrates (the problem) very well, but I know it's happened at other hospitals."
Indeed, Ryan O'Connell, vice president of performance and risk management at Bridgeport Hospital, said the hospital works to make sure staff members don't assume an issue or problem will be addressed by someone else. This applies not just to large teams of physicians working on a single case, but to day-to-day medical care.
A few years ago, the hospital instituted what O'Connell dubbed the 3-foot rule.
"If you're within three feet of a patient when they raise a concern, it's your responsibility," he said.
The hospital also encourages non-medical staff, including housekeeping workers, to report something that seems amiss, O'Connell said.
"We're developing a culture of safety in which everyone is empowered to speak up when something is not right," he said.
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