The "By-Stander Effect" in Medicine

Several recent incidents have caught our attention these past few days: the measles outbreak in Metro Manila, the Philippine HIV crisis and what we can about it, a recent death of a beloved doctor and student Dr Zuriel Arambulo by hit and run. However, one social media post gone viral got our attention, especially since it occurred in Cebu (again).

Standing and taking pictures does not do much in helping someone in distress.
Image from: http://www.mtholyoke.edu/~asif25s/bystander.htm

This post was inspired by a recent video involving a critical patient in the emergency room of a district hospital in Cebu that had gone viral on social media. Watching it opened the floodgates of all other medical mishaps caught on video and posted on social media. Questions come to mind: where were the health professionals attending to this bleeding man? Knowing the patient is in a critical condition, why wasn't somebody doing first aid or emergency procedures to try to save his life? Whoever took the video had time to shoot the video, but no time to help?

Before we judge those in the video, let us ask ourselves first if there had been ANY incident in the past where we saw something that was happening was wrong and yet we failed to lift a finger to help.

Image from: https://psychologenie.com/bystander-effect-social-psychological-phenomenon

The By-Stander Effect

When people are asked if they would be willing to help in an emergency situation, most people would say yes. In reality however, people refrain from helping when there are other people around. The "Bystander Effect" was termed after the circumstances under which Kitty Genovese was murdered on 13 March 1964. Even though she screamed for help, her neighbors did not come to her rescue. Thus, also known as the Genovese syndrome, the bystander effect is a psychological phenomenon that theorizes that the greater the number of bystanders present, the lesser is the likelihood of any of them coming forth to rescue the person in distress. The term was coined by psychologists John Darley and Bibb Latané in 1968, after they conducted a series of non-dangerous or violent emergency-based experiments to find out why the witnesses in the Kitty Genovese murder did not help her.

Image from: http://www.historynaked.com/kitty-genovese-syndrome/

Helen Dodson of Yale University explains in her blog that the "bystander effect," which refers to people standing by and doing nothing while an emergency situation takes place, can also apply to medical care. Can you give examples of bystander effect in medicine?

Hortensius and de Gelder (2018) posit that three psychological factors are thought to facilitate bystander apathy: the feeling of having less responsibility when more bystanders are present (diffusion of responsibility), the fear of unfavorable public judgment when helping (evaluation apprehension), and the belief that because no one else is helping, the situation is not actually an emergency (pluralistic ignorance). Can you think of the impact of the by-stander effect on patient safety?

Patient Safety

Last June 25, the Department of Health promoted the National Patient Safety Day. Although this was to raise awareness on the risks of hospital-acquired infections, several medical societies have undergone training on patient safety, such as Team Strategies and Tools to Enhance Performance and Patient Safety (teamSTEPPS) to optimize patient outcomes by improving communication and teamwork skills among health care professionals - a strategy to reduce the by-stander effect. Suggest ways how to prevent the bystander effect in hospital settings.

In the end, all we have to answer for is our own conscience. As the old adage says, "evil men will triumph when the good man does nothing". I would also quote another champion of his time, Arthur Ashe when he said "Start where you are. Use what you have. Do what you can."

Image from: http://www.saryan.info/arthur-ashe-quote.html

Data Privacy

The Data Privacy Act is another issue in this discussion, but not the primary issue at hand.  Republic Act Number 10173, otherwise known as the Data Privacy Act of 2012, is a law that seeks to protect all forms of information, be it private, personal or sensitive.  To comply with this law, each hospital should have a data privacy officer.  With everyone having a social media digital presence, hospitals should have social media policies to guide them regarding what can and should not be posted on social media.  Healthcare workers should always think that "first of all, do no harm" and question their motives in shooting a video of a patient without their implicit consent.

Image from: http://www.martijnboersma.com/boards-failing-corporate-social-responsibility

Innovations for HIV Awareness Campaigns

We keep doing the same things, and expect HIV cases to decrease.  This is the time to introduce innovations to raise HIV awareness, reduce HIV stigma and discrimination and to prevent the transmission of HIV.

Current Situation of the Philippine HIV Epidemic

Statistics from the DOH Epidemiology Bureau indicate that as of September 2018, there were 59,135 total reported cases of HIV in the Philippines since 1984, with 32 new cases per day.  Sexual contact remains to be the predominant (98%) mode of transmission, 85% of whom were males who have sex with males.  Of the 56 newly diagnosed females in September 2018, four were pregnant.  Of the 954 newly diagnosed cases in September 2018, 271 (28%) were young, aged 15-24 years old.

A recent Lancet correspondence article by Gangcuangco in February 2019 recommends six steps to curb the epidemic:
1.  Stigma reduction through education.
2.  Increased HIV awareness among healthcare providers
3.  Availability of pre-exposure prophylaxis
4.  Integrase inhibitors should be used as first-line ART, such as in the combination of tenofovir, lamivudin and dolutegravir (TLD)
5.  Primary care physicians should be empowered to provide HIV care to overcome geographic barriers
6.  Substance abuse should be addressed and mental health be promoted

If we are not insane, then we need to introduce innovative changes to address the Philippine HIV Epidemic.  Inclusive unified efforts to strengthen the collective power of all HIV advocates!

References:

DOH NEC EB HIV/AIDS & ART Registry of the Philippines September 2018 accessed February 13, 2019 on https://www.aidsdatahub.org/sites/default/files/publication/EB_HIV_September_AIDSreg2018.pdf

Gangcuangco, Louie Mar A.  HIV Crisis in the Philippines: Urgent Actions Needed.  The Lancet. Volume 4, Issue 2, PE84, February 1, 2019 accessed February 13, 2019 on https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30265-2/fulltext?fbclid=IwAR13e8EUEtkGoNS2Cp2kvRX22mMiagU_-D-7EZmsB2jrqOCoo6OC9_YLAyM

CONNECT: Rest, Reflect and Reset

 REST, REFLECT, RESET

For someone who is always on the go, I find it so difficult to stay put. I guess I wouldn't put it past my doctors to admit me to the hospital just to force me to stay in bed, complete bed rest without bathroom privileges. As my resident trainee Sittie would say, she would sedate me just to make sure I take my rest...

The day after my discharge, I stayed home, but not in bed. I spent the day with my niece and I felt thankful that she appreciated my presence despite her willfulness.  While she enjoyed watching videos naked, I made test questions for the next day's examinations - a simple activity that soothed and relaxed me, making me weird that way.  It was a day for resting.

The next day we spent visiting our pigs, ducks, dogs and goats at the farm in Carcar City.  It was an extended day to spend with family and to enjoy what we have.  It was a day for reflecting.

This morning, after dropping off my sister in law and my niece to attend her ballet class, I joined the mothers (and father) of our scholars during the parents' meeting.  It seemed like fate's joke that their chosen topic was about kidney health.  A mother of a scholar with nephrotic syndrome prepared "bam-i" pancit for us, while another gave a well-researched lecture with Manila paper visual aids and another shared her experiences and challenges in taking care of a chronic kidney disease patient. 

We talked about things to avoid to maintain healthy kidneys, like too much salt, processed foods, high potassium-containing foods, sugar and soda.  We also did a 5-minute zumba dance session to encourage exercise and active lifestyle without being strenous, just to keep moving!

It seemed so weird that I was the medical doctor, and yet these were mothers and housewives telling me how they worry about their children eating right.  They said that the healthiest food is the food that we prepare ourselves.  I think of my mother who prepares my baon everyday and complains that I eat out anyway.  I remember how mad she would get if I don't finish all the food she prepares.  I just hope that she doesn't give up on me, no matter how she berates me that I am physically older than she is.  This is definitely a day for resetting.

Appreciate Yourself

APPRECIATE YOURSELF

Stemming from Dr Gia Sison's 14 day of Self Love Challenge, I write about how it applies to my present condition.

I was so struck about the #SelfLoveChallenge that I felt this is what my prescription be like, as my cardiologist ordered for me to rest and take it easy for a few days.  You see, last Monday I had chest pains and when we got my blood pressure, it was 160/100. We went to the ER to have it checked out with ECG just to make sure, and I never got home that day because I was admitted to the coronary care unit (for close monitoring). I was following my doctors' orders and had all tests done just to make sure I wasnt having a heart attack.

I had time to REST, REFLECT and RESET. I had some major decisions to make about lifestyle change.

My mother asked me "what do you intend to give up?" and I had no answers to that. I felt like I was binging in a work buffet and I had to just choose what I would consume and let go of everything else. I APPRECIATE that I am working as hard as I could to do everything in my power to improve systems, to help trainees, students and scholars, to campaign for my advocacies. However, like everybody and anybody would tell me, I am simply working too hard.  I need to slow down.

I appreciate the work that I do makes a difference. I appreciate that I don't have to do everything and that I can delegate. I appreciate that I have family and friends who care for me. I appreciate that I am a beautiful person, a child of God.