Saturday, January 26, 2013

The Perils of Respect Culture

In much of my writing I have criticised the respect culture of Korea because it has harmful effects on relationships, causes arrogance in older people, fear in younger people, and generally causes unnecessary stress all round.  I have always had no problem with respecting older people who are retired or significantly older, but the silly stuff of being forced to respect people who are even merely a year older than you or have a few months more experience in a job has always seemed like a severe complication of life to me.

There are situations, however, when the culture of respecting one's elders is not only a nuisance but logically ridiculous and even extremely dangerous.  I was party to some information regarding the later last week and it did not surprise me one bit.

To explain this I will need to do a brief background on my wife's profession, a nurse, which she took a break from recently because of the stress of the job and to study English.  There are many problems with nurses in Korea, they are well trained at university but once they start their jobs this doesn't continue, they work by routine and are encouraged not to use their brains and take any responsibility.  They are servants for the doctors, the only one's that deserve respect and indeed command awe from everyone as well.

In England, nurses are required to do at least one year as a regular nurse before they can specialise, say into a surgery room nurse.  This is needed because they need the experience and mentoring of older more experienced nurses and doctors in a variety of real life circumstances.  Once they have the experience they would have to do further extensive training to specialise.

In Korea, a nurse needs no extra qualification to be a surgery room nurse, they are just thrown in at the deep end and criticised heavily when they make inevitable mistakes.  A bit like a lowly private in the army, they have their errors forced out of them by constant pressure from superiors.  Younger nurses are shouted at, ordered to make coffee, cut fruit, do all the washing-up in the staff rooms, are made to do the majority of the work, and are bullied by older nurses (on top of everything else a nurse has to do) because the respect culture gives them the right.  Younger nurses fear to ask questions about procedures because of this and are also afraid to contribute their point of view in puzzling situations involving the health of patients.

With this in mind then, perhaps it is easy to understand how the following situation happened.  I gained this information through a nurse working in a hospital near where I live in Korea who was a friend of my wife.

The hospital in question specialises in orthopedic medicine - basically bone and joint surgery - which has its quota of extremely over-worked nurses both in wards and in surgery rooms.  I was told of a gentleman who had been anesthetised and was waiting for the doctor in the surgery room with three nurses present.  The following should be worrying if you are planning an operation any time soon in Korea.

The nurses noticed on the vital signs machine that the patient's systolic blood pressure (the highest figure that is normally about 120 mmHg, diastolic is usually 80 mmHg) had fallen to just 50 mmHg.  Now, anyone with even a modicum of knowledge of medicine would now know that this is very much time to take some action, if not panic.  The first instinct of these nurses, though, was to assume that the machine was faulty.  While they were checking the machine the patients BP was falling further, now at 40.  Thinking that this might be time for the doctor to examine this anomaly they called asking for him to come to the surgery room but politely and without too much haste or urgency.  By the time the doctor arrived the patient's systolic BP was now 30 mmhg, basically he was virtually dead.  The doctor immediately called for support and began chest compression while others arrived and whilst screaming expletives at the nurses.  The patient then went into cardiac arrest and the defibrillator was required as well as adrenaline shots to save his life.

Fortunately, they were able to bring the man back from the brink but we need to examine further just how this situation came about and what was done in the aftermath.

Of the three nurses present at the scene, two were senior and one was a nurse of about 3 years experience but had only recently joined this particular hospital, so she was of a much lower status than the other two.  The least experienced nurse smelled a rat immediately upon noticing the patient's blood pressure reading (she was the one telling the story) but did not say anything other than a polite inquiry to the older nurses about how they might call the doctor, which she was scorned at for mentioning.  It was the older nurses who were not so concerned with the situation, the younger nurse's opinion did not count and vital minutes were lost that could have resulted in the patient's life being lost.

Once the patient was stable he was moved to a different hospital to recover and the doctors and nurses wondered what might have caused his problems.  He had no prior medical complaints, no issues with his heart or lungs or any other organs.  But one nurse told of a similar experience she had in another hospital of a man who had an almost identical situation because of an allergic reaction to the anesthetic they used.  Upon revealing this to an older nurse, who was calling the hospital that was receiving the patient, her suggestion was laughed-off without a second thought and she was told to not be silly.  Considering they still did not know the cause of the man's condition, this was irresponsible at best.  This suggestion was, however, made later in the day by the older nurse, who claimed it was her idea.

Maybe it is tempting to blame stubborn older nurses - one should bear in mind that when I say 'older nurses' this can mean that they are only a few years older and there are not many nurses older than 40 years old working in Korea - but it is the culture within the hospitals of the doctors being so highly respected to the point that they do not respect the opinions of the nurses that is to blame here, and this in turn makes the nurses not respect their own opinion.  This makes them less inclined to use their own initiative and think and act for themselves.  It is also more than a little troubling that hardly anyone, doctors included, thought outside the box and wondered whether the anesthetic could be the cause.  I would have thought that this would be a fairly obvious possibility.

From the information I have been gleaned in this case and when my wife was working, it is clear that Korea utilises nurses as more of a general dogs-body and assistant rather than a genuine medical professional, placing very little value on their position and they rank fairly low in the hierarchy at a hospital and given little respect for what they do.  Is it any wonder the nurses in this situation failed so spectacularly to take responsibility and realise the gravity of the position they found themselves in.

Now, whether you believe this story or not - perhaps it was just a younger nurse embellishing things and telling a more dramatic story than what really happened and making herself look good in the process - it should be taken seriously and the logic of what is supposed to have happened fits very well with some of the issues involving respect culture in Korea.

I am inclined to believe this story just because of what I have heard before from my wife about the treatment of younger nurses in her hospital and how little regard more experienced nurses and doctors have of their rights and opinions.  But there are also some other curious stories coming from other areas of life in Korea that make this so believable.

In the not-so distant past, Korean Air's safety record was not one to be proud of and many of the disasters were caused by pilot error.  The reasons behind this were to do with the process of favouring older, ex-military fighter pilots in the recruitment process and the culture of hierarchy in the cockpit itself while flying, in which the pilot of the plane would rarely listen to or respect his co-pilot's opinion, which caused fatal mistakes.  A full explanation of the issue can be seen in this article in the Wall Street Journal.  At one point of the article it tells of how Korean pilots would actually punch their co-pilots in the arm when they did something wrong or did not agree with what they were doing.  During a training simulation in the US a Korean pilot did the same to his American co-pilot but instead of receiving fear and respect the American simply said, 'do that again and I will break your arm!'  In my view, the correct response.

Also in the Wall Street Journal, this article highlights the headaches of respect culture on business and on the South Korean national football team before Guus Hiddink took charge prior to the 2002 World Cup. He was startled to find that younger players in his team felt obliged to pass the ball to the senior players, hampering the team's ability to improve.  In business, similar problems occur with older people taking all the highest positions regardless of their qualities.  Another complication is that employers are loathed to hire older people for lower positions in companies because of the discomfort people feel in being their superiors at work and ordering them around, so age discrimination is rife in Korea for this reason and many older people who are out of work find it difficult to find jobs.

For all these reasons and more then, I guess you could say I have genuine misgivings about the moral worth of respect culture in the way it is currently operating.  It is not just a harmless difference between cultures it is dangerous, illogical, inefficient, causes a great deal of unhappiness and stress in some people, and a good deal of arrogance and over-confidence in others.

It is a shame some common sense can't be applied to this part of the culture because when you first come to Korea it is quite nice to see young people respecting those that are much older than them, their parents, their grandparents and their teachers.  It makes for such pleasant youngsters when compared to many of the disrespectful yobs back home in England.  Once someone leaves school, however, surely everyone's opinion should counted and be equally valued (in school too), and the freedom to speak out in a situation which requires it should be welcomed as heartfelt concern rather than ridiculed or despised because they disrespectfully challenged the authority, age, and position of someone else.

Make no mistake, this needs to change; it took plane crashes, a sub-standard football team, and reduced efficiency and therefore profits in business to make them realise it in these situations.  What would it take to realise the effects it has in hospitals or on the population at large?  A few deaths on the operating table for one and maybe some proof that the country has problems with stress and unhappiness for the other.  I wonder what could show this?  In case anyone doesn't know, Korea has one of the highest suicide rates in the world.  I am not suggesting that respect culture is the sole cause for it but perhaps it doesn't help the situation very much.  It is time for Korea to have a rethink on this particular traditional value and practice.



  1. As an asian in Europe, this is very true.... the respect culture in asia that really annoys me. In order to get your opinion counted, you must force your seniors to feel threatened, so that they would consider your opinion.

    1. Thanks, it is a pity that younger people have to struggle so bad to get themselves heard.

  2. Thanks for the article of insight into sk, I had no idea this actully went on. Hospitals I thought this would actually cease in because your there for the life of patient. They need to have their nurses step up regardless of the doctors professionals this is such a wonderful information blog.

    1. Yep, unfortunately lots of politics in working relationships in Korea.

  3. Good stuff. You write well and it's great topic. If you ever wanna write for Haps, drop me a line.


  4. I can't even imagine such scenario described here happening in Nigeria, dose staff wl face a serious panel session. D nurse is a thoroughbred professional, equipped wt excellent theoretical, practical n scientific skills to " treat human responses in health and illness."-as American Nursing Association defines it. Nursing is respectful of different cultural peculiarities of clients bt nt bogged down by it. Korean Nurses better wake up n deal wt dese irritations quick. The female nurse is nt a geisha, nor a commercial sex worker. I seriously dnt thnk such hospitals wl wnt to hire me afta jst 2wks, cause i jst won't tolerate such rubbish. For gdness'sake, ds is d 21st century.

    1. Yes, exactly. The culture in Korea values doctors, but it really doesn't value nurses or respect their skills and hard work. The wages and working hours are proof enough of this, but their treatment at work is also appalling.

      You're also right about the solution; nurses need to stand-up for themselves, stick together and force a better arrangement for themselves and not accept the crap. Society's responsibility also to move forward in their attitudes towards nurses and women (because in Korea nursing is basically a woman's job, which of course need not be the case).

  5. I totally agree with your article.
    I lived more than 5 years in Korea.
    I would like to also let you notice the strong macho culture in Korea.
    I am woman, I studied M.S. in Korea and worked 2 years for Samsung. And I must tell you I feel distressed about korean women situation. I do believe they do not have opportunities in their own country.
    I saw in Samsung the economic violence against women. Female employers seem to be transparent, they take longer time to be promoted, many leave their jobs or stay to endure the denotations of their inferiority and non importance.
    I would say that in the korean business environment, korean male are first, forein male are second (from any nationality and color), korean female are third and foreign female are the least.
    Other issue you did not mention is the high discrimination toward foreigners that depends on the genre, nationality and skin color.
    Exactly as you wrote, these issues exist everywhere, however in Korea, the situation is extreme.
    I really congratulate you for your good article. You introduced the situations very respecfully.