A sad week
On February 2, Jon Huntsman Sr., the founder of Huntsman Cancer Institute at The University of Utah, passed away peacefully at home.
Many tributes have been made and obituaries written for this extraordinary billionaire businessman, philanthropist, visionary and, above all, family man. To summarize the events and achievements in his remarkable life would far exceed the word limit of this editorial and have been captured already in the many articles already in print. As someone who had the good fortune to meet Mr. Huntsman several times during the last 5 years, I was always struck by his absolute commitment to his family, to the mission of our cancer center and to the patients who receive their care here.
His concern for and love of our patients was truly heartwarming. It became well known that navigating Mr. Huntsman through the cancer center on a visit required allowing extensive additional time — any trip from point A to point B in the building was punctuated by multiple stops to share a hug, a kind word, a greeting or a story with a patient. Having witnessed such “journeys” on many occasions, I remember him not just for the qualities listed above, but for his concern for our patients and our staff, and for his humility and civility toward others.
However, many events in the last year and some specific episodes in this sad week of his passing lead me to believe that we are losing the meaning of civility in our workplace.
Loss of civility
There are many definitions of civility. I particularly like the definition from the Institute for Civility in Government — “Civility is claiming and caring for one’s identity, needs and beliefs without degrading someone else’s in the process.” This definition embodies the principle of mutual respect, which should lie at the heart of our interactions with colleagues and patients.
Many of our frontline staff in the clinics and in the inpatient floors are experiencing erosion of the concept of civility and an increase in behaviors which, even a year ago, would have seemed rare, beyond the range of what’s normal and acceptable, and yet understandable given the extraordinary stress our patients and their caregivers suffer during their cancer journey.
Our staff are compassionate health care professionals who place the wellbeing of their patients first and foremost in their professional lives. Yet, they are increasingly confronted by patients, family members or other caregivers who manifest their frustration, anxiety and worry in the form of verbal abuse, racial slurs or, in rare cases, threats of violence.
I should point out that, fortunately for us, these are still rare events but, without the benefit of reliable data, my colleagues and I all share an impression that abuse and intimidation of our staff have increased in the last year.
Especially distressing has been the apparent rise in the number of racial slurs. It’s difficult to attribute this to any particular societal change, although it may not be coincidental that comments from some of our nation’s leaders in past months have reset the threshold of acceptable language and behavior. It seems as if some individuals now feel more emboldened to express their intolerance of others, using the level of national dialogue as their guide. We have seen a couple of these episodes in this last week, reinforcing the sadness expressed in the title of this editorial.
Finding strategies for managing this trend has been challenging for us as cancer care providers. The fundamental guiding principle is, of course, that the best interests of our patients and attention to their care remains the number-one priority, coupled with the safety of and respect for our staff.
Balancing those two needs can be tough.
How, for example, do we deal with a white patient who demands that all care is provided by a white nurse? Although our approach to this situation is very clear — patients and family members are told we will not comply with such requests and will not tolerate racially directed comments against our staff — other factors come into play. Knowing this background, the charge nurse assigning staff to that patient on the one hand may feel that we must adhere to this principle but, on the other hand, knows this may then place a staff member from a minority racial background in a very uncomfortable situation. As a result, we may consciously or unconsciously play into the bias of the patient, and only assign a white nurse.
Zero tolerance vs. forgiveness
Like many centers, we adopt a robust zero-tolerance policy for threats or verbal abuse of our staff, backed up by our security services, but this has to be moderated by the understandable stress that family members feel during treatment and gauging how much this behavior is “excusable” based on the situation of the patient or caregiver. This is a difficult judgment call for compassionate health care providers who, for the most part, are likely to err on the side of understanding and forgiving rather than zero tolerance.
We also have to acknowledge that this is a two-way street. Some of our patients from racial or ethnic minorities have strong, culturally embedded reasons for requesting caregivers of a specific gender or who are from a specific ethnic or racial group. Although this may be in conflict with our own cultural beliefs, as far as possible, and as long as patient care remains the priority, we should try to respect this.
There is a significant body of published literature confirming that verbal and physical abuse of health care workers in the United States and in parts of Western Europe has increased. Based on the demographics of our patient population in Utah, I suspect we are well below the national average in experiencing these events but, even here, we believe we are seeing an upward trend.
Navigating these challenging situations — often highly distressing for our staff — remains a challenge. We continue to work toward finding the best way to keep our staff respected and valued, and providing the best care to our patients and their families.
I certainly don’t have any solutions, but can’t help feeling sadness that our center, founded by a man of huge stature and boundless civility, has experienced examples of the erosion of mutual respect during the very same week he passed away.
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John Sweetenham, MD, FRCP, FACP, is HemOnc Today’s Chief Medical Editor for Hematology. He also is senior director of clinical affairs and executive medical director of Huntsman Cancer Institute at The University of Utah. He can be reached at firstname.lastname@example.org.
Disclosure: Sweetenham reports no relevant financial disclosures.