Teaching compassion and respect. Attending physicians' responses to problematic behaviors

Area of Science:

• Medical Education
• Professionalism in Medicine
• Patient-Physician Communication

Background:

• Attending physicians play a crucial role in shaping medical learners' professional behaviors.
• Negative attitudes toward patients among trainees can undermine patient trust and care quality.

Purpose of the Study:

• To investigate how attending physicians respond to learner behaviors indicating negative patient attitudes.
• To understand the underlying reasons for attending physicians' response patterns.

Main Methods:

• Participant observation of inpatient general internal medicine rounds.
• Semistructured interviews with medical teams.
• Thinking-aloud tasks with attending physicians.
• Patient chart reviews.

Main Results:

• Attending physicians identified disrespect, corner-cutting, and hostility as problematic learner behaviors.
• Responses were infrequent, often passive (nonverbal cues) or indirect (humor, self-interest, medicalizing issues).
• Direct feedback on attitudes or norms was rare; reasons for non-response included perceived ineffectiveness and lack of reward.

Conclusions:

• Attending physicians are reluctant to directly address negative patient attitudes due to uncertainty about effectiveness and appropriateness.
• Indirect communication strategies are employed to avoid confrontation but may be misinterpreted by learners.
• Subtle feedback mechanisms may be insufficient for correcting problematic attitudes in stressful clinical settings.