The impact of a designated cancer unit on house staff behaviors toward patients

To examine the impact of a subspecialty care unit on house staff behavior toward patients, fourteen internal medicine teams were observed in 1213 interactions with patients on morning rounds using a previously devised instrument, the Physician Behavior Check List. The eight teams assigned to the hematology/oncology unit (HO teams) saw significantly more cancer patients than did the six teams assigned to general medicine floors (GM teams). Patients seen by HO teams were sicker (P less than 0.001). Hematology/oncology teams engaged in fewer support behaviors, particularly with the sickest cancer patients, than did the GM teams. Teams did not differ on time spent with patient or patient involvement but HO teams were rated significantly lower on addressing the patient's needs. The authors propose the concentration of sick cancer patients on a designated cancer unit diminishes house staff ability to engage in supportive behaviors and to address the needs of patients during morning rounds.