Ever Heard of the ‘Hofling Experiment?’ Not Likely. It Isn’t Something Healthcare Gets Too Chatty About

The Infamous Hofling Hospital Experiment

Dr Charles K Hofling

Boy, did the good doctor Hofling open a few eyes to medical reality

It was just a bit over 50 years ago – in the summer of 1966 to be exact – when a psychiatrist by the name of Charles K Hofling thought it would be interesting to see just how willing nurses might be, to carry out dangerous instructions by doctors. So he hit upon a rather sneaky idea: He’d have ‘pretend doctors’ call in to hospitals by telephone, and direct the nurses who answered to do whatever they were told to do. Wow. Now how about that?

Hofling’s findings were more than a little bit shocking, even for the 1960s.  Because even though hospital protocols forbade drug administration in such circumstances (an unknown physician over the telephone) the experiment revealed that almost every nurse directed to give patients what would have been a drug overdose – did so.

The Scenario

A man, unknown to the nursing staff, calls in to a hospital and says he is a physician. He identifies himself with a fake name, and tells the nurse it is important to administer an immediate 20 milligram dose of a fictitious medication called Astroten, to a specific patient. He says he will sign the patient’s chart for the drug order tomorrow morning. A small bottle of Astroten (actually harmless sugar pills) has been secretly placed in the drug cabinet where the nurse normally works.

Now, not only was there no such drug as Astroten in the whole wide world, (so no nurse or anybody else could possibly be aware of potential side effects) the fake label on the vial clearly stated that 10 milligrams was the only safe dosage. To double the dose of nearly any hospital-strength drug is dangerous, and a serious breach of medical protocols.

Oh, and here’s another little aspect of the Experiment worth noting. Prior to the test, 12 nurses and 21 nursing students were assembled and told of the plan to test nurses at random. They were asked to predict how many nurses would actually administer the medication, knowing it was wrong to do so. Only 2 of the 12 experienced nurses – and none of the 21 nursing students – believed the nurses who took the call, would actually follow the “doctor’s” order.

Hofling then chose 3 unidentified American hospitals and picked 22 nurses at random. They were each telephoned by a member of the experiment team who identified himself as “Doctor Smith,” who directed them to administer the drug. The man on the phone said that he would, “sign the drug order on the patient’s chart when I get to the hospital.”


Trust us: As a 30-year Paramedic, we’ve witnessed more lab coat gorilla flare-ups than we can count. And nurses pretty much do whatever is necessary to avoid the outrageous drama. Read “The Paramedic Heretic” for a peek at an insider’s view, of how rescuers have to deal with what is known in the business as ‘disruptive physician’ madness.

Each nurse who obeyed the dangerous order was stopped at the door to the patient room, before they could actually administer the “drug”.

Now, as you may or may not already know, any nurse in such a scenario was supposed to  refuse “Doctor Smith’s” instructions, on these solid, medical/legal grounds:

  1. Hospital protocols were clear: nurses were to only take medical directions from MDs known to them. They should not follow orders given by an unknown doctor over the phone
  2. The drug in question was a complete unknown to the nurses
  3. Drug orders were to be signed by the MD before they were administered
  4. The dosage they were instructed to administer was double the safe amount

The Ugly Conclusion?

The Hofling Study revealed that 21 of the 22 nurses would have indeed given patients an overdose of a medication they knew nothing about, ordered by a stranger’s voice on the phone, had they not been stopped. Not one of Hofling’s study team – and only one experienced nurse who saw the plan in advance – accurately guessed the troubling results. The study also found that nearly half of the randomly selected 22 nurses had already given patients medication, ordered by unknown MDs on the telephone in the past. And some had done so numerous times.

What the study exposed is the very real danger to patients that exists, when nurses suppress good judgement for fear of physician bullying. And you’d better believe this kind of intimidation continues to this day.*


Take a good look at the findings of this Foundation for Better Care, 2013 nurse survey. It shows with absolute clarity that 97% of nurses experience “conflict” and/or “unprofessional clashes” in the patient-care environment.

Our Question of the Day:

So what do you suppose is going on between the nurses and MDs at your local hospital, in the year 2017, when it comes to physician intimidation? How many modern-day nurses allow themselves to be pressured into mistreating patients? Send us your thoughts and experiences we’ll publish then in a follow-up article.


2 thoughts on “Ever Heard of the ‘Hofling Experiment?’ Not Likely. It Isn’t Something Healthcare Gets Too Chatty About

  1. leejcaroll says:

    This follows sadly sound psych principles. Think was Zimbardo who did the jail experiement and had to call it off quickly because the role plying turned into abuse. (You know the one some students played guard some inmates)
    This also reminds me of the case some years back where some ( ) called into a fast food restaurant said they were a cop to essentially abuse a demale employee and the people did it.
    This is terrible finding but it just reminds us nurses (and doctors) no different then the rest of us.
    When I was a college student I volunteered in a pre med program. I wore the long white coat. Despite name tag clearly stated college student volunteer I had patients treat me as, and ask questions of me, as though I was a doctor.
    The issue may be intimidation but it is also training so nurses know, with no uncertainty, they are to follow strict protocol. (I also notcie in the red type rules a contradiction they are to accept the orders only from docs they know but cant give the drug without being signed by the rdering MD. If the order is over the phone it cannot be a written and signed order.
    Doctors call in orders all the time. They cannot be in the hospital 24/7. It is incumbent on administration and nursing schools to teach that intimidation or feeling bullied is not sufficient reason to disobey and potentially put patuents at risk (Of course best line of defense? Get rid of the bullies who call themselves doctor)

  2. Two blogs about “intimidation”. Bullying is everywhere. I am a puppeteer for “Kids on the Block of San Diego”. We use puppetry to talk about diversity, multi-cultural issues, physical and mental disabilities, tolerance and much more. “Bullying” is our most requested program. “Start talking about this when they are young” I have been told. How do we get through to these intimidators? What role models do these kids have: politicians, policemen, tycoons, lawyers, and doctors? The list is too long!

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