Too Many Doctors Can Hurt a Patient in 'Bystander Effect'

Jan. 3, 2013— -- An acutely ill man with mysterious symptoms -- a nasty rash, kidney and lung failure -- was admitted to Yale-New Haven Hospital where he was treated by 40 of its finest doctors.

But because so many cared for him, two of the attending residents say, the 32-year-old patient actually got sicker. That is because of the so-called "bystander effect," they say in an article published today in the New England Journal of Medicine.

Authors Dr. Robert R. Stavert and Dr. Jason P. Lott argue that because of changes in health care, more specialists get involved, leading to "decay in coordination of care."

The psychological phenomenon, also known as "Genovese syndrome," was first coined in 1964 after Catherine "Kitty" Genovese, 28, was stabbed to death in New York City as others appeared to have been aware of the attack and did nothing, although the number of bystanders has become a matter of dispute.

One witness told police at the time, "I didn't want to be involved."

A large body of research now shows that humans are less likely to offer help in an emergency when others are present. The key factor is "diffusion of responsibility": the larger the group, the less likely an individual will act.

"We have talked a lot about the broader issues of healthcare -- and not just within our field -- and it really struck a chord," Stavert, a resident in dermatology at Yale, told ABCNews.com. "We came to realize that the people involved were really excellent doctors and all worked with really good intentions but it became apparent the pitfalls people could fall into."

The patient the Yale team treated spent 11 days in intensive care, but nine sub-specialty units were tending to his case, causing "more of a handoff" of responsibility, the authors wrote.

"Our inability to easily name his disease process quickly created ambiguity about 'ownership' of the patient," they say.

"While our team sat in a remote rounding room pondering potential causes of the patient's rash, another team of intensivists gathered in the ICU hallways to debate his ventilator settings, while yet another consultation team sat at a distant ICU desk, struggling to understand his multi-organ failure."

The patient had more than 25 diagnostic lab tests and two imaging procedures daily, many of them "duplicative and unnecessary."

"This cloud of medical purgatory lifted only when acute decompensation occurred, forcing the doctor-of-the-moment to act decisively," they wrote.

"This happens all the time in medicine," said Lott, who, in addition to being a resident in dermatology at Yale, is a clinical fellow at the Robert Wood Johnson Foundation. "You make your best guess and keep your fingers crossed and it turns out for the best."

The "bystander effect" is often seen among witnesses to crimes.

For two hours in 2009, as many as 20 people watched or participated in the gang rape of a 15-year-old girl outside a homecoming dance at her school in Richmond, Calif.

Hundreds of students who had gathered in the gym nearby took photos and some even laughed.

Ervin Staub, founding director of the doctoral program in the psychology of peace and violence at University of Massachusetts, has devoted his career to the study of how a person can become an "active bystander," the witness who is in a position to take action.

He is now just finishing the book "Roots of Goodness," about moral courage and heroism. In it, he attributes the phenomena to the bystander effect: diffusion of responsibility and plural ignorance.