Patient Disrespect Causes Preventable Emotional Harm

Besides providing medical care, hospitals must also devote attention to emotional harms that may damage a patient's dignity, according a new report.

Researchers at Beth Israel Deaconess Medical Center (BIDMC; Boston, MA, USA) authored a report that details the work BIDMC has done over the years to promote dignity and respect during patient care, following their 2008 effort to publicly report a variety of patient safety issues. Building on that work, BIDMC has made a significant commitment to defining the loss of dignity and respect as a preventable harm, and taking active steps to prevent them.

The BIDMC multidisciplinary “Respect and Dignity” workgroup is comprised of representatives from across the medical center, including health care quality, patient safety, ethics, social work, interpreter services, patient relations, and the patient family advisory council. The workgroup defined emotional harm as something that affects a patient's dignity by a failure to demonstrate adequate respect to his person, and made a commitment to identify and track emotional harms using the same databases used to document physical harms.

Examples include a failure to conduct a sensitive conversation in a private setting; misplacing or losing sentimental objects; or worst-case "never events," such as sending a funeral home the wrong body after a patient has passed away. The definition also acknowledges that not all emotional harm is a consequence of a human failure to demonstrate respect; a patient may be embarrassed by the need to use a postsurgical colostomy bag or harmed by the lack of privacy because a hospital does not have enough private rooms. The report was published on June 17, 2015, in BMJ Quality & Safety.

“Ensuring that our profession does not cause preventable harm to our patients requires that we address emotional harms with the same rigor we have applied to physical harms,” said senior author Kenneth Sands, MD, MPH, BIDMC senior vice president of health care quality. “There are many challenges in this work, including establishing operational definitions of 'respect' across culturally diverse patient populations. Overcoming these challenges should become our mission as we fulfill our fundamental ethical responsibility to ‘do no harm.’”

“Emotional harms can erode trust, leave patients feeling violated, and damage patient-provider relationships,” concluded lead author Lauge Sokol-Hessner, MD, associate director of BIDMC inpatient quality. “We do not have reliable estimates of how often such harms occur, but some evidence suggests that they may be more prevalent than physical harms.”

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Beth Israel Deaconess Medical Center