Bystander effect leads to poor patient care

By Mel Borup Chandler, ksl.com Contributor | Posted - Jan 30th, 2013 @ 11:46am



SALT LAKE CITY — A new article in the Jan. 3 issue of the New England Journal of Medicine highlights a phenomenon informally called the bystander effect and how it can cause "chaos and inaction."

It's formally known as the “Genovese syndrome,” which refers to an incident involving Catherine “Kitty” Genovese, who was murdered in the early morning hours of March 13, 1964 in plain view of 38 witnesses, all of who assumed someone else had called the police or otherwise helped.

In this perspective article, doctors Robert R. Stavert and Jason P. Lott, both third-year residents at the Yale School of Medicine, likened the bystander effect to ongoing medical dramas experienced every day by patients.

The doctors, both dermatologists, were involved in a case of a patient who had 40 doctors participating in the patient's care during an 11-day stay in the ICU. The doctors wrote, “The simple question of 'Who is my doctor?' now has a longer, complex and often unclear answer.”

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According to the writers, when a large group of people (in this case, medical professionals) is involved in treatment decisions, it is likely that the mantle of responsibility is overlooked on the assumption that those responsible for taking action have already taken appropriate action: “This cloud of medical purgatory lifted only when acute decompensation occurred, forcing the doctor-of-the-moment to act decisively.”

Decompensation is a medical term that describes the functional deterioration of a patient. It may be brought about by fatigue, stress, illness or old age.

According to the authors, these problems are in part the result of “increasingly stringent limits on resident work hours, born of appropriate concern about physician fatigue and patient safety.”

The perspective proposes that increased medical specialization and subspecialization has led to an increase in the average number of doctors and other professionals involved in the care of a hospitalized patient — all of which may result in a decay of coordination of care.

Moreover, “the lack of consensus among providers was exacerbated by a sheer overgrowth of testing-related data. On average, more than 25 diagnostic laboratory tests and two imaging procedures were performed daily, many of which were, in retrospect, duplicative and unnecessary.”

The doctors stress that health care professionals must remain mindful of how their behaviors may change when responsibility for providing care is dispersed across many physicians.

"It may be deceptively easy to assume a passive role and conclude that another physician will bear the burden of authority and patient responsibility when that may not be the case.”

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To resolve the problems, the doctors refer their colleagues to utilize a recent initiative: TeamSTEPPS, or Team Strategies and Tools to Enhance Performance and Patient Safety, which was developed by the U.S. Agency for Healthcare Research and Quality.

To further illustrate the problem, the doctors cite a recent face transplant at the University of Maryland Medical Center — a process which "involved more than 150 professional staff members working together for more than 36 hours.”

The aim of the TeamSTEPPS program is to improve communication and team-based skills among health care professionals.

“We should capitalize on opportunities for transcendent teamwork in modern medicine, lest we find ourselves unwitting bystanders at times when patients desperately need our help,"” the perspective states.



Mel Borup Chandler lives in California. He writes about science-related topics, technological breakthroughs and medicine. His email address is mbccomentator@roadrunner.com.

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