Sunday, May 8, 2011

The Manners Mother Taught Us

Theresa Brown, an oncology nurse in Pittsburgh, didn't connect her column in today's New York Times to Mother's Day. But I did.

Ms. Brown tells this story about a recent event at her hospital:
It was morning rounds in the hospital and the entire medical team stood in the patient’s room. A test result was late, and the patient, a friendly, middle-aged man, jokingly asked his doctor whom he should yell at.

Turning and pointing at the patient’s nurse, the doctor replied, “If you want to scream at anyone, scream at her.”
Ms. Brown was the nurse, and the column, written with the doctor's permission, is her response.

Bad interpersonal behavior creates patient safety risks. Nurses, and young physicians, stop raising questions or sounding alerts. But Ms. Brown observes that the most corrosive form of bullying isn't the loud tantrum - it's "passive, like not answering pages or phone calls, and tends toward the subtle: condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward insults."

I have the privilege of teaching medical ethics to first year Harvard Medical students. We discuss the deep moral conundrums in which cherished values compete and clash. These are the "capital E" ethical issues that make the evening news. But the "small e" ethics that Theresa Brown writes about are more important for every day patient care.

In the feedback I received from patient surveys over the years I was impressed with how many of the comments focused on behaviors that ultimately derived from the lessons in "good manners" that my mother (and father) taught me as a young child. I remember their saying "if you make an appointment, don't be late." There was no occasion to teach about returning phone calls promptly, but when the mother of my best friend in fourth grade died, they insisted that I call him. And the one time I remember my father spanking me (with a hairbrush, no less!) was after I'd treated someone doing housecleaning for the family with disrespect.

Albert Schweitzer taught that "Example is not the main thing in influencing others. It is the only thing." Ms. Brown follows Schweitzer's lead. The milieu of hospitals and other health organizations will improve when "alongside uniform, well-enforced rules, doctors themselves set a new tone in the hospital corridors, policing their colleagues and letting new doctors know what kind of behavior is expected of them."

This isn't the ethics taught in medical ethics classes. It's closer to the good manners we were taught, or should have been taught, as kids. If we're lucky, the behaviors have become second nature, automatic. But the right kind of example among our teachers and peers can reinforce or reduce our propensity to treat patients and colleagues with ordinary human decency.

I'm sorry my mother isn't alive so that I could thank her for lessons I often groused about as a kid. Insofar as I imbibed the practice of considerate behavior, it's served me as well as any of the fancier lessons I learned later on!


Martha said...

Wow, this piece hits home with me. Be kind, be honest, work hard and take responsibility for your actions. Be willing to fight for what you believe and be willing to fight for others that cannot fight for themselves. This is ETHICS.

Jim Sabin said...

Hi Martha -

90% of the things that disturb us about the ethics of our health system would be resolved if your precepts were followed reliably!