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An experiment showed that hospital staff were ready to kill patients

Illustration for article titled An experiment showed that hospital staff were ready to kill patients

The Milgram Experiment is infamous for showing that people, in a situation they didn't fully understand, would shock another person to death if ordered to do so. But what if people did understand what they were doing? As it turns out, that could actually make things even worse.

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In 1966, the phone rang at Hofling Hospital. A night nurse picked up the phone and heard a harried doctor ask her to administer 20 milligrams of astroten to Mr. Jones. The nurse checked for the medication, which was not on the official list of drugs approved for use in the hospital. The box containing the drug showed that 10 milligrams was the maximum dose. A little prodding from Dr. Smith, who knew the nurses weren't allowed to take orders over the phone but said he would be in to fill out the order paperwork later, and 21 out of 22 nurses administered the drug.

The drug turned out to be a sugar pill, and the doctor on the phone was a researcher conducting a study to see whether hospital staff would break protocol so dramatically. The results were not encouraging. True, the nurses' jobs were potentially on the line. And unlike electric shocks, which everyone knows do damage, the nurses had reason to believe withholding the dose would do as much damage as giving it out. Still, the idea that trained medical professionals would give a clear overdose to a patient on the word of some guy on the phone was shocking.

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It's also thought-provoking. We like to think that we're more sophisticated, independent, or just security-minded, than people in 1966, but if the study were performed today we might get one hundred percent compliance. Ever since the 1960s, we've been inundated with narratives about the individual going against the rules of the slow-moving, heartless, bureaucratic "system." How many times have we seen movies where the hero begs someone to break the rules "just this once." People who don't play by the rules are lionized, and rules are seen not as a guides set in place for safety or accuracy, but as agents of mindless conformity - or even sinister conspiracy. Would another Hofling be impossible today? Or would it be even more likely?

Top Image: Bradley J

[Via Simply Psychology]

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DISCUSSION

acpaul
Amy Paul, RN

As a nurse working night shift in the ICU of a busy hospital, I have several problems with this.

First of all, nurses can and do routinely take doctor's orders over the telephone. It's just not possible for the doctors to be in several places at once. Do people really think that the surgeon leaves the operating room with a patient on the table in order to run down to ICU and write a necessary order? Not a chance. So, telephone orders are common.

Secondly, I know the name of every doctor who has privileges at my hospital, I have met almost all of the ones I would ever deal with, and have spoken on the phone with them enough to recognize their voices. More specifically, I know which doctors are taking care of my patients, who's on call, who's on vacation, etc. I wouldn't take an order from a doctor I didn't know.

Thirdly, I look up every medication I give to my patients unless I've given it so many times that I have the information memorized. And I'm not the only person checking. When a doctor gives me a medication order, it first has to be faxed down to pharmacy, where an actual, live pharmacist reviews that order in light of the patient's diagnosis, known allergies, and other medications already being given.

Medicine, and in particular, nursing, has gotten so regulated that I am forced to spend more time on my computer than taking care of my patients, and I blame, in part, studies like this, and articles like this for the fact that I have to double and triple chart every little thing I do. I wouldn't ever give a patient a medication on the say-so of some random person who doesn't even have privileges at my hospital, and you can rest assured that the medication I do give have been legally ordered, verified, researched, and charted in four different places.