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New post up at My Take of the Bystander Effect in Medicine

Healthcare looks much different than it did just a few years ago. When you let your mind wander about where we were, it’s shocking really.

There’s cultural changes, including an explosion of complexity of care, an infusion of young doctors with different ideas about life, an evolving set of incentives, employment models and a heck of a lot more bureaucracy to muddle through, not just those dreaded computers.

In-hospital care looks the most different. For starters, there’s many more people involved in the care of a patient in the hospital. Call them bystanders if you will.

I live in this world everyday. To a great degree, Electrophysiologists are hospital doctors.

I recently wrote about my take of the Bystander effect in healthcare. Perhaps I was moved to write about it because of my first hand experience last year when my Mom got so ill. I included this experience in the post.

Here is the start:

When two dermatologists wrote in the New England Journal of Medicine that in-hospital care has grown fragmented and bloated, they sounded a pertinent message for all doctors, especially specialists.

The issue of the piece was that the bystander effect has grown more prevalent in healthcare, especially with hospital care. The bystander effect, otherwise known as the Genovese syndrome, refers to the phenomenon in which the more the bystanders, the less likely it is that someone will help. It has to do with diffusion of responsibility.

The dermatologists described a complicated case they shared with 40 other doctors over 11 days. If you have been (or have had a loved one) in the hospital, you may have recognized some of the things they described. Groups of doctors met outside the patient room and talked with themselves but not to other doctors or family.

It happens every day in most big hospitals. ICU docs work on the vent; infectious-disease docs pour over culture results; blood doctors look at the blood parameters; kidney doctors adjust diuretics; and heart doctors say the patient needs more tests. Invariably, electrophysiologists get called when the patient’s overwhelming inflammation causes a dysrhythmia.

I hope you want to read more.  It’s over at Trials and Fibrillations on


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