Communication becomes exceedingly difficult when there are deeply imbedded hierarchical and school of thought barriers between parties, and nowhere is there a more relevant example of the negative effects of such a system than modern hospitals. As mentioned in the first two parts of this series, medical errors can occur due to anything from misread dosages to misunderstood status reports on a patient traveling to a different department. However, communication within departments, specifically between nurses and physicians, can lead to some of the most heated and legally complicated medical errors.
Historically, the hierarchy between doctors and nurses existed because, in patriarchal Western cultures, nurses were women and doctors were men. Though outdated, gender-based power issues are still a problem, especially with older male physicians who continue viewing the largely female nursing workforce as subordinate. More generally, medicine is quite paternalistic; there is still a general perception that doctors are in charge, and their orders are to be followed by both nurses and patients alike. This means that if a doctor chews out a nurse after being challenged by her, that nurse is less likely to speak up the next time. This hierarchy does not lend itself to comfortable dialogue – a dialogue that could be essential to the wellbeing of these professionals’ patients.
Additionally hindering communication is that nurses and doctors are trained differently, so their approach to treatment and care is different. While nurses are trained to view the patient holistically, physicians are taught to focus on “the case” and determine treatments and cures without necessarily considering the social, emotional, or cultural factors that affect the patient. Nurses are typically socialized to press for consensus, whereas physicians are intent on ruling out alternatives. The lack of co-education can lead to resentment and disrespect, while complicating communication between nurses and physicians.
Nurses perceive that physicians don’t recognize their scope of practice and autonomy, while physicians express frustration with nurses’ communication style, which they find disorganized, illogical and including extraneous or irrelevant information. They speak different languages, and a simple, direct task given by a doctor could be met with questions and concerns from a nurse. Just ask any seasoned nurse and they will likely regale numerous examples of this miscommunication and potential for medical errors or near miss medical errors.
Without mutual respect, trust, and understanding of differing professional perspectives, communication between nurses and doctors can lead to serious harm for patient. How can this impasse be remedied? The final article in this series will focus on solutions to such causes of medical errors.