Three Billboards Outside of Ebbing, Missouri: Redemption is not Assured

I couldn't imagine, as I sat watching "Three Billboards Outside of Ebbing, Missouri", that I was the only person for whom the name "Flannery O'Connor" came to mind. She is another one of my favorite thinkers.  I am certain I have written sometime in these pages. I can't say she was one of my favorite writers. Her short stories, particularly "A Good Man Is Hard to Find" wherein an entire Southern family, elder and child, is shot to death by an escaped convict, whose life without any moral compass motivates a life of pure "meanness", are hard to take. Always, in O'Connor's tales, hidden within the grotesque, is the possibility, with Grace bestowed, of Redemption, accepted, or refused. There is the potentiality of good in all of us, however lost, or as Catholicism puts it, "we incline toward the good" but still do evil if we do not actively choose or embrace the good.

I have read the letters of Ms. O'Connor, compiled in a book called "The Habit of Being" and read more than one biography of her.  I consider her something of a modern saint, but her writing always disturbed me to avoidance. I read a few of her stories.  I read about all of them. It was, no doubt, one of her goals to disturb, which after all, is a reality of life from which we cannot escape and which provides the soil in which we either select the light, or the darkness.

When the unsettling (disturbing) movie concluded, I immediately googled to see what connection had been made to Ms. O'Connor, her writing, and her themes by critics. There were many. And it turns out the connection even flashed on the screen, though I was not sufficiently observant. One of the main characters is reading O'Connor shortly after the movie begins.  One review was fixated on the backlash against the movie because the Sam Rockwell character, who plays a rather stupid, drunken (and mean, if it comes to that) cop, is a racist and is effectively "redeemed" without any real contrition or act demonstrating it. For my part, I think that complaint misses the point. The guy is an equal opportunity hater. And whether he, or anyone in the movie, actually achieves redemption, is the open question at the end of the movie. Let me back up and give you the story.

IF YOU DON'T WANT TO KNOW WHAT HAPPENS, THEN DON'T READ ON, FOR THERE ARE SPOILERS.

A mother has lost her teen-aged daughter to a particularly vicious crime. Angela was raped, murdered, and set on fire until fully charred. The family is Tennessee William's decrepitude. They routinely yell vile curses at each other over the breakfast and dinner table. It is during one of the cursing matches that the daughter asks for, and is denied, the family car.  She stomps out saying she'll walk to town, and hopes she will be raped.  Her mother's last words to her are the same--she hopes her daughter is raped, too. She doesn't mean it, of course. The precise profound evil has occurred when the movie begins. Mildred, the mother, is in angry pain, the presenting anger being that the police haven't solved the crime after many months. They don't, from her point of view, seem particularly motivated to do so. The Chief of Police (Willoughby) is an upper middle aged guy, with a young wife, and two young daughters. She gets the idea if she can publicize the failure, maybe something will get done. So she rents three broken down, and unused (since 1986) billboards leading to her house, paying the first month of five thousand dollars by selling off her ex-husband's tractors, boldly asking why the Chief hasn't solved the murder. The town isn't particularly happy with Mildred, as the Chief tries to tell her that he has done all he could and that the DNA matches to no one in the criminal system, and that it appears to have been done by someone passing through town.  More than that, though she knows that the Chief is dying of pancreatic cancer. Her prodding him to solve the murder seem profoundly unfair. When he shoots himself, not because of Mildred's complaint about lack of action, but because he doesn't want his young wife and young children watch him die slowly, Mildred's persistence is nonetheless blamed.  Her anger remains steady, no matter whom it hurts, and it is certainly hurting her remaining child, Robbie, a teenage boy, as well as her domestic abusing ex-husband who has solved his pain by running off with an airhead 19 year old. It is he, not Dixon, the nasty cop, as one would suppose, who ultimately sets fire to the billboards, unable to bear the pain of being reminded of his daughter's death and wanting to move on. As it happens though, there are spares of the posters, and Mildred replaces them on the burnt damaged billboard.

Dixon, played by Rockwell, is incensed from the start and embarks on a program of bullying, physically, and otherwise, to get the billboards removed--which includes throwing the young guy who works for the billboard company (Red) out of a window, after beating him, first. Beating people is his go to thing, and, once again, before the events of this movie, he beat a black man--with apparently no consequence to Dixon. The consequence for beating the young guy, who happens to be white, meted out by the new black Chief, is to lose his job.

Willoughby, though, in one of his penultimate acts before shooting himself in the head, is to write three notes, one to his wife, explaining his reasons for suicide, assuming that she could not possibly bear his last months had he not so acted, one to Mildred to say that he did care about her daughter's death, that his act had nothing to do with her, though, rather cruel tongue in cheek from the grave, he tells her he knows that people will think so, and one to Dixon, telling him that he is a good man (shades of a "Good Man is Hard to Find" again") and could be a good cop. While Dixon is surreptiously reading the letter in the police station (for which he still has a key) late at night, Mildred throws several mazeltov cocktails, thinking that no one is inside. Touched by the letter that Willoughby wrote, Dixon manages to grab the file on the murder of Mildred's daughter and jumps through the flames to the street. Mildred isn't caught because the guy who puts out the flames on Dixon, a dwarf (played by Peter Dinklage) who has always fancied the ever sour Mildred, covers for her.  Mildred is only grateful enough to go out to dinner with her alibi, but without a modicum of charm or kindness toward him.

Dixon, scarred by his burns, but otherwise more or less physically intact, drunkenly overhears a customer passing through Ebbing at the local watering hole bragging about raping someone. Rather than just report the man and his license plate (Idaho) he picks a fight and with the DNA evidence all over his bloodied face and nails, he brings it to the new Chief. Also, foolishly, he tells Mildred of his suspicion. He is apparently trying to reform. But the DNA of the stranger is also not in any criminal database, and he was out of the country (a military man) when Mildred's daughter was murdered.

Nothing has changed. Dixon's reform is a jagged line without a period. Mildred is disappointed and still in her so far unending rage. He calls Mildred while he holds a large shotgun in his hands. He suggests a trip to Idaho where the legally exonerated suspect lives. Mildred picks up the cue by saying that she was planning to go to Idaho "in the morning."

So, they pack up for a road trip. Along with the munchies, Dixon's shotgun gets thrown into the back of  Mildred's station wagon. They speak no words for a long time. Then they justify that in Idaho lives a man who did rape someone, even if it wasn't Mildred's daughter. They wonder if they will really do it. They aren't sure. They'll decide when they get there. The movie ends. There is another opportunity for redemption. But given the history of these people, it is not assured.

I usually don't like movies of this sort, particularly with the violence and profanity. Though there were some questionable plot point explanations (see it, you'll see them; it's not my focus here) the writing was great; the acting great. I could believe these people exist, and their struggles are like my struggles, even though I live is balmy, sophisticated Los Angeles, and not in the decadent, still politically incorrect South (my guess is people are just as politically incorrect here, but more careful). What I mean is that every day I face decisions, small mostly, but occasionally, large, in which I could lose my soul. And so much bombards us while we make those decisions, external and internal. When Grace does present itself, seeing the opportunity and keeping my soul, is not any more assured for me than it was for the characters in this thought-provoking movie.

Things Forever Unknown

My mother was an enigma. I have written that before, here, and elsewhere. I don't remember that we ever had a conversation about anything that connected us, emotionally. There was always talk of my grades, the ones I must receive, all A's of course, and the ones I did receive, mostly A's, except in handwriting and mathematics. There was talk of shopping, things she needed to buy at the A and P; talk of the laundry that needed to be done at the mat down the street and to be hung on the line on the tar covered roof at the top of our building. There was evasive talk of modelling her hands, though whoever she might have worked with were referred to with first names only.

My father said she wrote poetry; she sent him her efforts when he was in Georgia on assignment with the army back in the early 1950s. I have a book of poems written in pencil. I have had them since she died in 1974, but rarely read them closely, afraid that they might merely be the copying down of other, more famous, writers. You see, though my mother read voraciously, in my time with her, lots of modern, and not particularly academic, fiction, she never seemed to speak of anything substantive, not even her hopes and wishes. My father and I had a sense of what she wanted merely by virtue of her dissatisfaction, which was expressed non-verbally. I admit, all these years later, as I pick up the poems again, and read them, for the first time, closely, I didn't think her capable of writing prose or poetry, so I have had suspicions of these penciled relics, other than a book of the medication she took before she died, the only things I have left of her 43 plus years after her death.

I know little of poetry--notwithstanding having hosted, for years, a college radio program on the works of the famous ones. As I read the poems and a tiny bit of prose, now, seeing some, or feeling some imperfections of the novice, perhaps even a gifted one, I think these are her creations, not those of others. I even went on line and put in some of the phrases to see if anything popped up. It occurred to me she might have used the works of others as templates, but these may well have been all hers.

I am going to with my mother's far fewer works what I have done with some of my father's prolific writing. I am going to put some of them on this blog. My reveries about her, and these pieces are all that the world will ever have of her. She doesn't pop up in Google. She died long before Google was even an idea in anyone's head, at least any of us in the Bronx.

That she was a dreamer, that we all knew. She saw herself in a different life than the one in a lower middle class one (for many years till my father got his last job with the City) which was hers till the day she died. She really wanted to live in a place with a doorman. She got a nicer apartment four years before she died. But she never got the doorman.

Let me start with this poem. I see her writing on one of the stained glass cocktail tables that were a pride and joy of our place near Mt. Eden Avenue. She liked to sit on the floor. She could easily have written this and the other poems while sitting on the floor in one of her Chinese inspired lounge outfits, aware that her life was restricted to the back of a tenement in the Bronx that faced an alley.

So here's the poem:

Some say that I am
But a dreamer
And that I
Shall never be
Of use to a world
Geared to reality.
Let them speak
That profess to know
Of true philosophy,
For they are but
Slaves of time,
While my heart and I are free.


I wish that she and her heart had been free when she was well and healthy. I don't think they were, until she became aware that time was very short, and she was looking death in the eye. Then all the desires of this world fell away, and she was free--no longer dreaming with expectation.

Fulton Fascination

The year the Venerable Archbishop Fulton J. Sheen died, 1979, I was in the throes of a religious lapse. It had been ongoing for some nine years; I was still a few years from a reversion. Besides that, I was finishing up law school so that I easily missed or was otherwise oblivious to the demise of this significant Christian figure while I pursued a career milestone.  All these years later, having re-discovered, or, having first truly discovered him, his intellect and his homiletic brilliance, I heartily regret my cursory cultural awareness of him.

I knew he had been a progenitor of television evangelists. He began on radio, but an opportunity came for him to dive into the new medium of television, and so he did. He was on a major network, first Dupont, then ABC and even once hit higher ratings than the comedy star of the day in the 1950's, Milton Berle. Back then, religion wasn't forbidden to the public square, was even invited to trod upon it. His show had several incarnations, half-hour, black and white (well, there wasn't color until the early 1960s anyway), an hour, color. But I don't recall watching them growing up, and during my lapsi period, I wasn't much inclined.

Don't get me wrong. I never was angry at the Church, the way some of my friends were, many for whom that anger never faded. I had some personal issues which I felt, probably not unlike poor Judas (but fortunately, not as so directly grievous) did not lend themselves to forgiveness, at least by going through the mediation of a human being in Confession, however much the instrument of God Himself. Alas, what probably kept and still keeps many from the Sacrament of Reconciliation (Confession) is embarrassment that there's a man through whom one expresses sin and contrition to God. I suspect embarrassment is the genesis of the comment oft heard expressed by Catholics, and in part the reason for the short line at Confessionals, "I talk directly to God; I don't need to go through a priest."  And then, it was also the time in history at large and Church history. The translation to the people of the changes wrought by Vatican II, which it turns out weren't really dogmatic changes, was woeful and mostly incorrect. Effectively, the rug had been pulled out from under me when I was about age 11, and I gave up trying to sort it all out, by age 16. That was 1970. Bishop Sheen's show had left mainstream in about 1968, and I certainly didn't catch it in syndication.

Once I was back in practice as a Catholic (the slow return began in 1983, which was after the Bishop had died in New York and I had been two years in Los Angeles), still years went by until I discovered EWTN (Eternal Word Television Network) begun in 1986 by Mother Angelica. That discovery wasn't until the mid to late 1990s, for me. And there was Bishop Sheen, with flourish and fanfare, mesmerizing me about my rediscovered faith as well as about history itself. He was talking about a dangerous road for humanity and Catholicism way back in the 1950s.

Of late, though, perhaps because the world around me/us is, to my mind, so apocalyptic--I realize that there are many who believe the world, and parts of mankind, are much more progressive and wise than in times past so I am not trying to convince the reader of my sensibility on that subject, though it strikes me as confounding in the extreme not to see it--I have been spending more time with the Bishop's 50, 60, 70 year past shows and lectures. I once wrote here that I consider Dennis Prager a bit of a prophet--but he came onto the scene in the early 1980s, and our society was already pretty well on the rocky road to self-destruction. Sheen was seeing things at a time in society, post-war America,  had settled into a kind of dream of prosperity and confidence that began to be pride in man as the measure of all things. It had happened before; it was happening again. Sheen was a true prophet. Things were not so rosy in the soul of the society, be it the slow recognition of full civil rights for Black Americans, or the manipulation by those who would like to see the end of the American Experiment. I hesitate to say "Communism" because the only thing people remember is the foolish Joe McCarthy's misguided methods to address it, and in demonizing him (which he perhaps deserves, that is a subject for others), there was an odd embracing of a system that killed nearly 100 million people in its various incarnations.

With his deep set eyes that could sear a soul, Sheen looked into the decaying one of America and the world at large. As the 60's world-view dominated men, the words of a Sheen faded into obscurity, or were dismissed as the ramblings of a Church intoxicated fool. Except as history will show-I cannot prove it, no one can, but I am as certain as I am of my own existence--that man is again seeking to usurp what was ordained by God.  He uses the gift of free will that was intended to adore, not to contradict God.  I haven't yet seen all episodes of Sheen's show, or homilies, or retreat lectures, to be certain that he said that all that is left to us is prayer. But I am sure I will run across one.

Bishop Sheen is slowly wending his way to official sainthood. Well, slowly is a relative term because he has only been gone from the earth under 40 years and in Saint proclamation terms, it is very soon even to be denominated "Venerable" (first was "Servant of God", next is "Venerable", then "Blessed", then the gold ring of "Sainthood") given that some individuals were not declared saints for decades, or centuries after their deaths. It was Saint John-Paul II, himself a beneficiary of the change, who allowed for an "easier" process. Of course, whether someone is or is not a Saint is not determined by the official naming. Many have been saints unknown to the world at large. Those named stand as models for the rest of us--proof that it isn't impossible for the ordinary person.

As to Bishop Sheen, though, the process got interrupted by not very religious Diocesan infighting that is wending its way through the very secular legal system. As to me, I really would like to see him be named officially because there is, and was, something in him that seemed both part of this world and the one in which he now dwells. A prophet is someone given a special gift, or obligation, perhaps more it is an obligation, by God. He is not a soothsayer. He simply sees what is happening around him and speaks truth to secular power.  And to religious power that might be too secularly minded.

When I watch him speak in the videos, he is as alive as if he were here with us. I really admire him. I want him to be declared a saint.

I have my reservations. I would have reservations with any human being, for all human beings are frail. As wonderful as he was, Bishop Sheen did something that has, small as it might seem, troubled and troubles me greatly. It fuels my reservations.

Here was this well known, well educated, well decorated man of letters, and a priest, and he did this really odd thing, at least to me it seems odd, given his prestige. He lied on his resume by adding study and a degree from a University he never attended. In my old job, as a prosecutor of lawyers, this was considered "moral turpitude" because it was intended that the reader rely upon it. Why does such a minor aspect of a whole life bother me so much?  I am expecting perfection of what can only be an imperfect being. All saints were imperfect, as contaminated by the effects of original sin, and personal temptation, as all of us are. I suppose, in a way, that he did this increases the fascination I feel for the man who might one day be declared Saint. I will never know why unless and until we both meet in heaven. But everything else in his life, of which I know at least, indicated the holiness of sainthood.

As to that resume thing, when I see him (I hope) I will ask. 

A Residue of Anger

I have been sorting through my journals. A while ago, I ran across an entry which just plain made me mad. It was written March 23, 2008, a mere sixteen days before my father died, primarily of sepsis, although he had been diagnosed a year or so before with bladder cancer. I put it aside. Tonight, while working on bills at my desk, I ran across it again. I am going to transcribe it here for whatever posterity there is on the ether that is the net. First the entry, then the unavoidable commentary.

Call to Dr. U.

I have gone to all but two of my father's treatments.  One of the ones I did not go to, he was sent home because of infection.  He has had several infections (urinary) over the course of the treatments.  At least two or three times, when I went there, they seemed not to know why he was there.  He has seen the doctor maybe three times, the first for a quick discussion of what would be done (oh, and the stents being put in*), a discussion after the surgery and the recent cystoscopy, in which they had a conversation "the tumor is angry.", but because it was during treatment I did not hear what was said.

On Friday, there were some different receptionists and they had him give a sample, but did not seem to know why he was there again.  The woman at the desk asked me.  I told her.  I got called by (the technician) after he asked reception whether someone was with dad.  I have met (the technician) before and I guess I understand why he does not remember-so many people--but that is the problem with this assembly line. He told me my father had an infection (previously they haven't called me in for this sort of discussion) and gave him some meds.  Said to call him on Monday, which I did.  But I also asked to speak to the doctor.  The doctor called me back. I told him about my father's weight, that I had just seen how thin he is yesterday.  I asked him about the tumor.  Stuff that should have been told to dad, or to me, without our urging was revealed.  "He has good kidney function, but the stents have to be replaced."  I told him I wasn't questioning that necessarily, but I did not know if he would survive it.  I got the response. "It has to be done," rather than alternatives, if any.  He has elevated blood sugar.  I told the doctor dad had been misdiagnosed with diabetes a few years ago, and instead of allowing me further discussion, seized on it, that maybe it was diabetes.  But then, he said, "if he isn't eating". . . .  No solution, just a comment. "There are no active tumor cells."  The problem isn't the tumor.

I asked him what should be done.  And he said that, effectively, that wasn't for him, but for his regular doctor.  Apparently, if it is outside his particular activity, the rest of my father's health is not his bailiwick.  He did not want him to take any more antibiotics, though I said that my father believes he still has an infection.  "Well," he said, "we'll do a culture when he comes in and see."

So, I called (dad's internist) who he has to see before he has the stents removed anyway.

So, we did go to Dad's internist, who was as expected, non-empathetic and non-responsive, blaming my father for missing an appointment some time before this. He was there now, and there was little indication of anything other than indifference and arrogance. He saw how thin my father was, and said, with great authority, "I don't like what I am seeing!"  That, of course, was the point of trying to talk to the great healer. I'd ask something. He'd ignore me. But he wasn't doing much for dad. I got angry. I offered my unvarnished thoughts. Suddenly there was a hand around my left wrist. Dad intercepted me. Later, he said, he thought I was going to hit the doctor. "Dad," I said, "I have never hit anyone, why did you think that?"  He said, "You looked like you were advancing on him. He'd move back and you moved forward."  My father was pushed forward to the procedure--which was for kidney stents that neither he, nor I, actually understood the reasons for as he had bladder cancer and hadn't been having apparent trouble with his kidneys. He didn't want me to argue or push. I held my tongue after that. A mistake.

The day of the procedure, both before it and in one of those procedure prep rooms, dad kept telling me that he was cold. I should have realized something. Once, when he had a urinary tract infection, he had been shivering with a fever. I noted to the Dr. "he says he's getting cold."  The doctor, in his well pressed lab coat, looking at his check list, said, "He won't be in a little while," or something like that. This is when I should have read a riot act, but I wasn't the expert. That's what I tell myself. And this was an "outpatient" procedure. I didn't think it should be, but there it was. And Dad was eager not to stay in the hospital anyway.

Dr. U told me, after the procedure, that he had cleaned it all out. I didn't ask what it was exactly he had cleaned out. Infection? Dad did not feel well when he got back home and he was disoriented. I mistakenly assumed that it was because of the ambien he had been taking. I got his anti-biotics. I don't know if he ever took any. He went to sleep. "That's good," I thought. He hasn't been sleeping. At that point, when he went to sleep, well, not to be indelicate, but the product of his catheter, looked as I had been instructed it was supposed to be, normal. But when he awoke a few hours later, disoriented to the extreme, it wasn't. Ambulance. Emergency room. Seemed as if the testing was for anything other than what, in my mind having heard a lot about sepsis since, should have been obvious to the "experts". By the time he was in ICU, they had finally figured it out. Dr. U and the internist NEVER talked to me, and when they came, at least one time I know of, I was ushered out of the room by the ICU staff. I only learned after the fact that they had come. Four days after the outpatient procedure, my dad died primarily of sepsis.  This was April 8. When I saw the entry from March 23, my blood boiled again. He probably had that infection or some version of it, the one that became sepsis and killed him before the bladder cancer--and oh, yes, he had a long time heart problem, even quadruple by-pass nearly two decades before his death--on March 23.

Medical professionals or facilities, whether they be your internist, your surgeon, your urgent care, your ER, your hospital, they dismiss you, even when they don't really intend to do any harm. They get compassion fatigue. They think they have seen it all, so they miss what is right in front of their eyes. What do you know? You're just the family. And they succeed in too many cases, and there are still days, a decade after Dad's death in believing I was one of the people to whom it has happened, by their explicit or implicit annoyance or superior knowledge, to react to you for looking like a crazy person by insisting that what they thought or wanted to do, is profoundly incorrect. If they had listened back on March 23; if they had kept Dad in the hospital after the procedure--he would have let them if they made it clear the alternative was life threatening for Dad was tenacious about life--he probably would have been like his sister, who died after him at age 100.  But then, that's the other problem. Our society is indifferent to the idea that a 90 year old should live until 100. There is a sort of institutional attitude of inevitability that creates a medical and empathetic laxness.  And if you suggest it to them, they get their backs up.

I find that after a number of interactions with the all too imperfect medical maze, I am suspicious of every opinion. Much like I feel about car mechanics. I don't know enough to be sure that what they are saying is correct or not. They know that. And here's the thing. They are just as human as you or me.

What's the answer? I don't know. Become a professional advocate before the fact? I don't have the energy and I fear my anger at their lack of urgency about other people's lives that probably would not make me effective.

Oh, well. I am putting the original entry of March 23, 2008 away. My father is dead long ago.  As to him, that ship sailed back then.

Study: Doctors who are jerks are bad for patients, hospitals

February 18th, 2017by Steve Johnsonin Local Regional NewsRead Time: 3 mins.

POLL:Have you had an encounter with a rude doctor?

• Yes
• No

 

As Dr. Gregory House in the TV drama "House," actor Hugh Laurie crafted a compelling portrait of a rude, arrogant and self-destructive physician who upset his superiors, peers and patients in every episode only to redeem himself in the show's final moments with his brilliant solutions to his patients' illnesses.

But while a Dr. Jerk may make for fascinating television, it doesn't make for good patient care, and can be a magnet for medical malpractice lawsuits, according to a new study from Vanderbilt University Medical Center.

Vanderbilt researchers looked at complaints against surgeons from 32,000 patients who had operations at seven academic medical centers over the past two years, including Vanderbilt, Emory, the University of North Carolina, Wake Forest, Penn, UCLA and Stanford. They identified the surgeons with the most complaints, and then looked at whether their patients had suffered complications within 30 days after their operations.

They discovered that patients of the surgeons who had the most complaints were 14 percent more likely to have a problem post-surgery.

Dr. William Cooper, the study's lead author, said he believes the reason for the discrepancy is that surgeons who are rude or disrespectful to patients treat their operating room team members in the same manner, resulting in poor treatment for the patient.

"You think about a nurse in the operating room who says, 'It's time for the time-out procedures. Let's make sure we have the right patient, and are operating at the right site.' This is a standard safety procedure," Cooper said. "But if the surgeon says, 'This is a waste of time, let's keep moving,' over and over again, the nurse may stop bringing it up, and we know those are important. If in another setting a surgeon speaks disrespectfully of someone, they may be distracted and worrying about what the surgeon will do next and pay less attention to the task at hand."

While a 14 percent difference in complications from surgery may not seem significant, Cooper said on a national basis that would add up to $3 billion in extra costs to patients, hospitals and insurers.

Surgeons who get a lot of patient complaints also draw the majority of medical malpractice lawsuits, Cooper said.

"We know that 3 percent of physicians nationally account for 50 percent of patient complaints," he said, "and those same physicians account for 50 to 60 percent of the malpractice risk. So what that means is that patients are picking up something in their interaction with their doctor that did not sit right with them."

Cooper's work is not just academic. Vanderbilt has been working with 140 hospitals across the U.S., focusing on those who have a high number of patient complaints and medical malpractice cases.

"We have peer interventions with them and they drop their number of medical malpractice complaints," he said. "We have worked with 27,000 physicians and done 1,600 interventions, and 80 percent of those doctors have responded."

While this latest study focused on surgeons, Cooper said its conclusions apply to other health professionals as well.

"We do this work with advanced practice nurses and find very similar patterns," he said.

The Vanderbilt study is not news to local hospital executives.

"Medicine is a team sport nowadays," said Dr. Helen Kuroki, chief medical officer at CHI Memorial. "As physicians, we rely on nurses and other colleagues to watch our patients closely and advise us of any change in status. That requires a comfortable conversation in which nurses have to feel they can bring things to our attention that later don't turn out to be serious without any fear of reprimand."

"If a nurse feels that she has been treated dismissively or disrespectfully," Kuroki said, "she is not only less likely to report a problem, she is also less likely to share it with colleagues."

Both Cooper and Kuroki emphasized that getting feedback from patients is critical.

"We do surveys of many of our patients," Kuroki said. "We are looking for their input, their perception of the quality of their care while they are hospitalized. With physician behavior issues, we look for complaints from patients, plus behavioral changes from the physicians."

"This highlights the importance of the patient's voice," Cooper said. "If they have a health care expert who doesn't meet their expectations they should speak up and let the doctor and hospital know."

Contact staff writer Steve Johnson at 423-757-6673, sjohnson@timesfreepress.com, on Twitter @stevejohnsonTFP, and on Facebook, www.facebook.com/noogahealth.

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