Sick Talk

HOSPITALS

He must have been on drugs last night," said one nurse of a colleague. "He couldn't even read a chart."

Who could sit on such on such a juicy (though alarming) nugget of hospital gossip? Well, the nurse who passed it on should have,'at least for a few extra minutes. Trouble is, she said it in a public elevator, where any-one--including patients and visitors--could hear it.

Such inappropriate comments are all too common in hospital elevators, report researchers at the University of Pennsylvania. They warn that loose lips can sink patients' trust in their doctors, violate patient confidentiality, and add to the worry of already-stressed visitors.

Penn bioethicist Peter Ubel, M.D., sent a team of students out to cruise five hospitals incognito, keeping an ear attuned to devator chatter. Out of 259 rides where two or more hospital employees rode together, 14 percent included an ill-advised comment, Ubel and colleagues report in the American Journal of Medicine (Vol. 99, No. 2).

The remarks fell into four broad categories:

o Half of the faux pas involved violations of patient confidentiality. Personnel directly mentioned a patient's name or provided info that would reveal his identity to others ("The guy who runs company X"). The major offenders: doctors.

o Unprofessional remarks, mostly from nurses, raised doubts about the speaker's ability to care for patients. Sample dialogue:

Nurse 1: "You just can't assist on those procedures if you're this sick."

Nurse 2: "I have no choice, I have to work."

o Some comments undermine trust in the hospital's quality of care. One administrator told a colleague, in a crowded elevator, that a patient's death "was the hospital's fault." Other conversations, needless to say, came to a grinding halt.

o Derogatory remarks--like a snide reference to a well-dressed patient as "Mister Christian Dior"--not only reflect poorly on health care providers, but might worry visitors that their loved one will receive poor care if workers don't like her.

Comments like these have led many hospitals to install signs in elevators warning employees not to reveal sensitive information. But inappropriate comments are more than a public relations issue. Since studies show that doctor-patient interactions influence recovery, one careless remark could undo some of the benefits of high-tech medicine. Says Ubel: "People need to know that they can trust their doctors."

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