Describe the key points and the potential implication of Stanley Milgram’s 1963 study on obedience for patients’ behaviours within a clinical environment and radiographers’ professional conduct in the context of a hierarchical working environment.

Milgram’s question which initiated the thought for this experiment started by the dispositional attribution of the Germans. He questioned how the German Nazi soldiers could permit the termination of the Jews and the harsh treatment (Holah.karoo.net, 2019).  Milgram could not comprehend how the Nazi soldiers could act inhumanly without any conscience. The biggest question for Milgram was under what conditions would a person obey authority who commanded actions that went against their conscience (Mtholyoke.edu, 2019). This essay will explore Milgram’s study and his variations; relating to clinical environment and hierarchical working order. The variations which will be researched are the telephone orders, uniform variation , physical contact variation and run down office block.

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The aim of Stanley Milgram’s, Behavioural Study of Obedience was to investigate the level shown by members when told by authority to administer electric shocks to another person. The investigation examined the nature of human behaviours and its relationship to  hierarchical working order and conventions. The experiment helped investigate the relationships between group behaviour and blind obedience to authority. Obedience can be defined as compliance with an order, request, or law or submission to another’s authority (Lexico Dictionaries, English, 2019). The experiment was carried out as a controlled observation in a laboratory. It took place at Yale university; a prestigious place of education. The participants in the experiment were 40 males aged between 20-50 year old and a range of occupations and educational backgrounds. This increased Milgram’s generalisability with a varied range of occupations taking part. However, a downfall from this study is that there is a low generalisability in terms location as it was ethnocentric. Another disadvantage was, low population validity of this study was androcentric as the participants were only males (Yogi, 2019). Milgram advertised the experiment in a newspaper and asked for American male volunteers. Subjects were told that the was about the effects of punishment and memory (Medium, 2019). The participants were paid $4.50 as a convenience and was theirs’s to keep no matter the outcome. The type of sampling used were self-selecting and volunteer sampling.

During the procedure the participant was introduced to a strict looking experimenter; the authority figure wearing a white lab coat. One of the participates was a ‘teacher’ and one was the learner. They drew rigged lots to determine roles so that the naïve participant will always be the teacher and the confederate was always the learner. The learner was given shocks when they gave the wrong answers to questions the teacher asked. However, there were no actual shocks given to the learner. The only shock through the whole set-up procedure was a slight shock given to the teacher to show the authenticity of the experiment. The learner and the teacher were in separate rooms. The shocks increased every 15 volts up to 450 volts. Throughout, the authority figure gave prompts such as; “please continue”, “the experiment requires that you continue”, “it is absolutely essential that you continue” (Stanley, 2019). The results of this study were that 100% of participants obeyed the experimenter and delivered shocks up to 350 volts and 65% of participants delivered shocks up to maximum which was 450 volts. Additionally, 26 out 40 participants continued to the maximum voltage. (Stanley Milgram, 2019)

Uniform was one of the variation’s in Milgram’s study. Researcher left the room and was replaced by another person. This person was another confederate and without an official uniform and instead, was in ordinary clothes. During the experiment the confederate was suggesting to increase the voltage every time the learner made a mistake. The percentage of participants who administered the full 450 volts when being instructed by an ordinary man, dropped from 65% to 20% (Sage Journals, 2019). This percentage decrease demonstrated the significant influence of the uniform and the legitimacy is has. Individuals who are in positions of authority have a specific clothing that is symbolic of their authority (Khan, 2019). It indicates who is entitled to expect at their obedience.  was another study which showed that the power of uniform makes people obey orders. This can be related to clinical environment as there are hospital staff and different healthcare professions who are entitled to wear uniform (Timmons and East, 2019). For example, doctors, nurses and radiographers can be projected as people who have power over patients to an extent as it signals their biomedical authority as it signifies a profession’s identity. In terms of radiography hierarchy in a workplace, it is a code of conduct for radiographers wear appropriate uniform to demonstrate trustworthiness and integrity. (Sor.org, 2019)

The second variation which will be explored is the absence of authority. During this absent experiment condition, the researcher gives the participant who was administering the.  The researcher then leaves the teacher in the room. Due the fact the teacher and learner were in separate rooms, this lead to a significant decrease in obedience. The level of obedience decreased to 20.5% (Mcleod, 2019). Different levels of obedience can be devised by patients when they are within a hospital environment compared to when they are not e.g. at home. Patients tend to listen to healthcare professions when within the clinical environment as they know they will have members of staff monitoring their treatment or actions taken are essentially benefiting the patient. An example would be that a nurse or physiotherapist may encourage a patient to take their pills on time or do certain exercises and patients would comply as they know how important it is for them but most importantly, they do not want to ruin the relationship they have with the healthcare professions (Eprints.lse.ac.uk, 2015). Patients tend to think that if they are obedient they will be treated well rather than someone who is not obedient. REFEENCE. This is the same where the subject in Milgram’s study continued to administer the volts because the authority told him to continue was afraid of what could happen with him if he stopped. REF Secondly, since the subject was being paid to do that, even though he did not find it enjoying or knowing he was hurting someone, he was going to earn money. Relating to the patient and healthcare profession

 This can be linked to Milgram’s study because when patients are away from a clinical institution, some tend to not comply with the treatments instructed when they go home.

Getting paid – ruin relationship

Telephone orders was another variation in Milgram’s study. The researcher was giving orders to the participant administering the shocks over the phone. This means they weren’t in the same room as them and this lead to decreased obedience.   It is easier to resist the orders from an authority figure if they are not close by. When the experimenter instructed and prompted the teacher by telephone from another room, obedience fell to 20.5%. Hofling et al.’s (1966) Study of Obedience (Open.conted.ox.ac.uk, 2019), was an hospital study to see if nurses would obey a doctor even if it meant breaching hospital regulations and risking the life of patients. Nurses received a phone call from a unidentified doctor asking them to administer a drug to a patient. The dose of drug the nurses were asked to give were significantly high and would have been an overdose. The nurses then carried out to do so knowingly break hospital rules in a situation where a doctor tells them to, even if it could endanger a patient’s life. Although this study contradicts Milgram’s findings since it shows nurses did comply when the order was given over the telephone, it also supports Milgram’s study in how people obey authority figures since doctors are more senior than nurses. Another variable in a clinical environment is that radiographers have an authority over doctors and a responsibility for the patient by making sure any type of imaging is justified under IRMER protocol (Cqc.org.uk, 2019). This is especially shown in theatre where the radiographers are responsible for everyone to wear lead and for the protective shielding to be up.  Doctors may request x-rays which do answer clinical questions and instead increase radiation for patient that is unneeded.

Run down office was another variation in this experiment. The study did not happen in a prestigious university like Yale in the original experiment. This decreased obedience to 19 (45.5%) (Psychology Wizard, 2019). Patients more likely to follow health professionals orders when in hospital as they are authority. Hospitals have strict protocols in place and regulations that must be followed by patients. Therefore they are likely to do what nurses, doctors and radiographers as they are seen as high authority figures and health professionals in the patient’s perspective. This is a vital part of their patient pathways and care. Another variable would be a setting of a room or bed in which the patient will have to spend time in during their treatment. A clean and tidy environment provides the right setting for good patient care. Patients would expect anything they come into contact with to be clean, especially with the bed they will be spending their time in (Cleantex, 2019). It’s also critical to have clean linens and towels to help stop the spread of diseases and infections (AM, 2019).

In conclusion, Milgram’s study on obedience reveals the extent to which society’s behaviour is influenced by other people. Due to the situation the teacher obeyed the instructions which were given to them even though they did not want to administer shocks. This shows that people are likely to obey people who have a position of authority even if it may go against their personal belief. However since there are set protocols and guidelines set in place in a clinical environment it is an advantage. This ensures employers understand what is expected of them and what will happen if they violate the rules.

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