Defining the ‘Not My Patient, Not My Problem’ or “Bystander Effect’ in Medicine

by Gregg “Anthony” Masters, MPH

It’s been a rough ride since receiving the call at 7AM Pacific time on June 4th 2023 hearing the words:

“Gregg…. Anthony is in the ICU“.

Turns out after a fall from his bicycle absent a helmet and unconscious, he was taken by EMS (Emergency Medical Services) to the Emergency Department (ED) at Elmhurst Hospital Center, Queens, a “level 1 trauma center” and though owned and operated by the NYC Health and Hospitals Corporation is staffed (and ‘operated by’??) a teaching affiliate of the Icahn School of Medicine at Mount Sinai, (see commentary on the Icahn legacy, here).

Waking up, getting present in the moment, and learning more about the circumstances leading up to this event, I was able to book a seat on the ‘red eye’ that evening and arrived in the ‘Surgical Trauma Intensive Care Unit” (STICU) around 11AM Monday June 5th.

A brief consult with the chief of service in the STICU suggested a 6-7 day expected length of stay with possible follow-up rehabilitation for physical if not cognitive related issues (if any).

Fast forward to the expected date of discharge June 10th, while Anthony showed steady improvement daily, ie, ‘downgraded’ and transferred to an intermediate though still telemetry monitored, lesser acuity care unit, the day before the projected discharge he steadily ‘decompensated‘, becoming groggy (over medicated?) then listless, to non-responsive to seemingly comatose, then intubated and pronounced dead on Sunday, June 11th at 9:48AM.

What happened?

As someone at the bedside 10-12 hours a day, with two overnights at bedside during the train wreck beginning Friday evening, June 9th, I suspect the ‘NMP‘ or ‘bystander effect‘ was ‘in the room‘.

But what is this phenomenon and how does it factor into the picture of team based workflows and the commitment to high quality, effective interdisciplinary collaboration to optimize patient outcomes?

With an assist from ChatGPT plus, V4, the observed phenomenon is summarized as follows:

“Not my patient, not my problem” and the bystander effect are concepts that highlight issues of responsibility and intervention in healthcare. The bystander effect, originally described in social psychology, refers to the phenomenon where individuals are less likely to offer help in an emergency when “other people” are present, (and yes, there were many, just perhaps the not right kind) in the room when it mattered most for Anthony. This has been explored in various contexts, including healthcare.

In the context of medicine, “Not my patient, not my problem” represents a similar issue, where healthcare professionals may be less likely to intervene in cases that they perceive as outside their responsibility or beyond their direct patients. This could be due to a number of factors such as workload, fear of litigation, uncertainty about the situation, or lack of [effective] communication.

It’s important to note that this is not a universally prevalent attitude among healthcare professionals, but when it does occur, it can lead to detrimental effects on patient safety and care. As a result, many healthcare organizations and systems have implemented various strategies to combat this issue, such as multidisciplinary rounds, shared decision-making practices, and fostering a culture of safety and responsibility.

Articles and academic papers that discuss this topic generally emphasize the importance of teamwork, communication, and fostering a culture of shared responsibility in healthcare settings. They might also explore the psychological factors that contribute to the bystander effect in medicine, or provide case studies and examples of situations where this effect was observed. Training programs often address this issue by reinforcing the idea that all staff members are responsible for patient safety, regardless of their specific roles or the patients assigned to them.”

Who Is Anthony John Masters?

he’s a non famous ordinary guy who touched the hearts of so many…

Tony, ‘sea you again’

David Soleau

This above clip prepared by the amazing Brandon Kuzma aka ‘the Kuz’ shared at the post paddle out (Ocean Beach, San Francisco) memorial reception hosted by good friends at the Moongate Lounge at Mister Jiu’s (more about the significance of ‘the moon’ in the lyrics of the soundtrack, listen closely).

For those with a hard time following the narrative, they’re poignant (they haunt me) lyrics are posted below:

“Hey Moon” by John Maus.
We Must Become the Pitiless Censors of Ourselves.
Ribbon Music. 2011.

Lyrics:

i know it’s been so long since we saw each other last

i’m sure we’ll find some way to make the time pass

hey moon
it’s just you and me tonight
everyone else is asleep

hey moon
if i was to fall, i won’t fall so deep
though i doubt i’m gonna
you can wake me up if you wanna

and your pale round face
makes me feel at home in any place i happen to be
at a quarter past three

the moon chased the sun out of the sky
goodbye sun! the night’s begun
the moon chased the sun out of the sky
goodbye sunshine! the night is mine

hey moon
it’s just you and me tonight
everyone else is asleep

hey moon
if i was to fall, i won’t fall so deep
though i doubt i’m gonna
you can wake me up if you wanna

i would hate for you to hang there all alone the whole night through

hey moon, my old friend
hey moon, the night is coming to an end
hey moon, come back soon

==##==

Bye son.

Love you.

Will always see you in the moon and everywhere else I look,

Dad.

by