The one-up, one-down status that has been practiced for too long in medicine is ending, but not soon enough. Hillel would ask when.

Healthcare suffers from an unrecognized illness—disrespect of patients. Respect is an essential component of medical professionalism. Our verbal choices have a major impact on how patients and coworkers perceive us. Inappropriate language can also show a lack of respect.

Speaking politely indicates that you are professional. In a nutshell, maintaining the cornerstones of medicine depends on language. Do the “unwell” deserve any less?

Advances in medicine and technology have not changed the role of healthcare professionals. With this newfound technical ability comes a corresponding increase in the professionals' responsibilities. Are medical professionals treating patients with the respect they deserve as their knowledge grows? Consider the underserved or the aged in this new medical era. How many people still hold on to unconscious biases from their time in medical or graduate school or their clinical practice?

One of the primary responsibilities of healthcare professionals is to treat their patients with respect, according to many modern professional ethics guidelines (Codes and Declarations). It was only sometimes like this. Respect is nowhere to be found in the medical-ethical works of antiquity, medieval, or modern times.

This is true whether we are talking about ancient oaths, prayers, lists of commandments or counsels, or modern treatises on medical ethics. Therefore, respect is a contemporary attitude recently adopted in medical ethics. But how is this sense of respect put into practice in healthcare?

A cornerstone of safe care is patient engagement. Patients used to be kept out of most choices that affected them. Now, patients are given a checklist, and they actively participate in proactive and reactive measures, including medication reconciliation and involvement in assessments.

Patients often make unofficial, unrecorded contributions to safety that go unrecognized. However, additional focus is needed on patients’ capacities to actively engage in their safe care and a better comprehension of the necessary steps to make this possible. Professionals’ understandings of patient connections, trust, respect, and their conceptions of safe care are also lacking.

The Aretha Franklin Perspective (RESPECT)

"Etiquette-based medicine" is a practical approach to promoting professionalism in healthcare. As outlined by one physician, steps to incorporate respect into these interactions include:

First, ask for permission to enter. Wait for an answer before entering

Prove your identity by presenting your ID badge and introduce yourself

Shake hands if appropriate

Take a seat and smile.

Describe your function within the healthcare team.

Healthcare professionals also need to inquire about the patient's emotional state while hospitalized. Reconsider not using questions that only require a “yes” or “no” answer. This will open up a conversation that can be quite revealing in terms of symptoms and treatment.

Do we really need to remind doctors to perform things that are so obvious? The carelessness with which such procedures are not carried out is obvious to anybody who has ever been a patient or a provider, and as Samuel Johnson put it, “Man needs more to be reminded than informed.”

Recently, I noticed a woman's 100+ birthday celebration. The facility where she lived sought publicity while the woman may have desired a bit of attention, but which was more crucial remains uncertain. The woman probably had no relatives nearby or former neighbors from her previous home. Her universe revolved around those in the nursing home, and she was perhaps unaware that the administration had informed politicians and media of her birthday.

How did they all respond to this impending major event? The politicians brought bouquets, the residential facility provided a large cake with one candle, and one of the significant politicians gave her a T-shirt with the town's name on it. With a bit of encouragement, she held it up in front of her so photographs could be taken.

Looking back, how do you suppose she might have felt as the center of all of that attention? Surely, she might have enjoyed it, and having a cake and flowers would have been nice, but could there have also been an element of concern or even fear on her part? If she didn't do as they wished, what would happen after everyone left?

Above all, patients are extremely aware of what happens when their protectors or guardians leave. In fact, one reason I have always advised families to visit nursing homes during non-visiting hours is so that they can see what actually transpires when outsiders are not present.

Seminars and Training, Oh, My

I attended a webinar at a university rehabilitation center to address a specific mental disorder. The showing of patients' faces in the seminar's videos of patients and medical professionals providing training surprised me and others. Usually, we would anticipate that patient agreement had been obtained for this, but the particular group being treated may not have had the mental capacity to provide agreement. The professional leading the seminar never addressed the matter, and I wondered about the lack of confidentiality and respect.

Another area, where respect could be improved is when highly motivated hospital systems scoop up single practitioner offices. I have seen at least two instances where there was a total lack of respect for anyone with mobility difficulties. One in a practice that this hospital system had bought had a large, thick glass door leading into the waiting room.

There was no automatic door opener for anyone in a wheelchair, using a walker or cane, or having difficulty opening that heavy door. Anyone with such a challenge would have to wait at the door for someone to notice that they needed assistance. How do you think they felt when left to wait for someone to notice them?

There is no low exam table for people with orthopedic problems, particularly spinal problems in another multispecialty practice that the hospital network also purchased. How does someone who cannot step onto the two steps up to the exam table do it without pain or great difficulty and some sense of helplessness?

The physician examining the patient admitted there was no low exam table and that this was somewhat overlooked. The hospital system has since acquired more space and brought in more specialists, but have they included low-profile exam tables? That has been forgotten again.

No one is asking for anything more than the respect and consideration that should be extended for patients needing medical care of any kind. They should not feel they are coming hat-in-hand and asking for special consideration when we know that the laws have been written, and the oaths have been inscribed, that indicate they are entitled to this form of civility.

So, as Aretha, so wonderfully sang, all they're asking for is RESPECT.