Christopher A.D. Charles | The psychology of patient-staff experience at Bustamante
The recent altercation between a mother and a medical doctor at the Bustamante Hospital for Children that led to a shutdown of the accident and emergency unit for two hours became the major topic of discussion in the past week.
Psychological science can offer clarity about some of the various factors that led to this unfortunate situation and bring the emotionally disparate views that were espoused in traditional and social media into a cogent explanation.
1. INFLUENTIAL POWER
The first issue is the influential power that situations have on behaviour that people tend to underestimate. Social psychological experiments like the Stanford Prison experiment have shown how a study on prison life was stopped abruptly because the upstanding and well-adjusted students who played the role of prison guards started abusing the ‘prisoners’ (other research participants) because of the powerful influence the situation had over how they carried out their roles in the experiment.
Similarly, the working conditions in Abu Ghraib prison during the Iraq war influenced normal soldiers and their superiors to become ‘monsters’ who severely abused helpless Iraqi detainees to the shock and horror of Americans.
The situation at the Bustamante Hospital for Children involves a high doctor-patient ratio, long working hours for the medical staff, tired and overworked doctors (many of whom are sleep deprived), lack of adequate equipment and supplies, and other poor working conditions. Added to this explosive situation are concerned, frightened, and anxious parents, with their sick and crying children, who are experiencing very long wait times to see the doctor.
This situation is frustrating for both healthcare staff and parents, and frustration leads to aggression. Some healthcare staff members express their aggression by making insensitive and uncaring comments when they communicate with parents, and some parents become verbally and physically abusive.
2. COGNITIVE DEFICITS
The second issue is that parents and healthcare staff who are tired or sleep deprived, especially at night, tend to experience certain deficits that negatively affect the doctor-patient encounter. People who are tired or sleep deprived experience negative mood changes. Therefore, these people tend to become irritable with others, fuelling conflict. Also, sleep-deprived or tired people also experience cognitive deficits, and so tend to make less-than-optimal decisions because they exercise poor judgement that also tends to negatively affect what they say and, ultimately, their social interactions.
3. PARENTAL INSTINCTS
The third issue is the instincts of parental care and protection. For example, most mothers (and fathers, too) with a sick child in a hospital accident and emergency room view the illness as a national emergency. However, this is unlike a paediatrician who has seen hundreds or thousands of children and is professionally able to make the clinical distinction between emergency and non-emergency cases.
Therefore, empathetic communication from the doctors to parents is required to sufficiently address the concerns of frightened and anxious parents about their sick child. This requirement sometimes does not occur because of the situational time pressures of many ailing children waiting to be seen by the doctor. Effectively responding to the concerns of these parents will significantly reduce the likelihood of them becoming violent.
In the litigious United States, there tends to be a low doctor-patient ratio and better equipped and operated hospitals where doctors in children’s hospitals, for example, spend a lot of time addressing the concerns of the frightened and anxious parents, thereby reducing their anxiety.
4. ATTRIBUTION ERROR
The fourth issue is the fundamental attribution error. This error is related to our cognitive bias in under-estimating the power of situational influences on other people’s behaviour. Whenever people are overwhelmed by situations and they become aggressive, they tend to attribute blame for their behaviour to the situation they experienced. However, when other people in the same situation also become aggressive, these people looking on tend to attribute the aggression to the perpetrator’s flawed character and not the situation.
Therefore, frustrated parents at the Bustamante Hospital for Children tend to attribute the healthcare staff’s behaviour to the lack of care and concern these healthcare workers have for their sick child rather than the stressful workplace conditions.
These frustrated healthcare staff, in turn, also tend to attribute the parents’ verbal and/or physical aggression to their violent socialisation in Jamaica and not to the frustrating customer-service experience.
This blame game caused by the fundamental attribution error was very much evident in the media in response to the most recent mother-doctor clash at the Bustamante Hospital for Children.
Finally, the calls for better security at the Bustamante Hospital for Children to protect patients, visitors, and staff should be heeded. The authorities should also make it clear that persons who threaten, intimidate, or physically assault healthcare staff will be prosecuted. There should also be psycho-education for parents about how cooperation with medical staff is in the best interest of the healthcare of their children. There should also be more empathetic communication training for healthcare staff so that they are better equipped to reduce the tension with anxious and frightened parents.
However, violent confrontations will continue until we comprehensively address the systematic and cross-cutting imperfections in the health sector that frustrate healthcare staff, patients, and their relatives.
- Christopher A.D. Charles is a psychologist who teaches at The University of the West Indies. Email feedback to firstname.lastname@example.org.