Health care bullies

His test results were late, so the patient jokingly asked the doctor whom to blame. The doctor pointed to the nurse and said, “If you want to scream at anyone, scream at her.”

Was this just an offhand comment? A not-very-funny attempt at humor? Or a subtle, belittling insult?

Theresa Brown, an oncology nurse and guest writer for the New York Times, took on the sensitive issue of physician-vs.-nurse bullying in a weekend piece titled “Physician, heel thyself.” She writes:

This vignette is not a scene from the medical drama “House,” nor did it take place 30 years ago, when nurses were considered subservient to doctors. Rather, it happened just a few months ago, at my hospital, to me.

As we walked out of the patient’s room I asked the doctor if I could quote him in an article. “Sure,” he answered. “It’s a time-honored tradition – blame the nurse whenever anything goes wrong.”

Brown then goes on to lay bare some of the internecine warfare that can take place between doctors and nurses. Much of it, she writes, doesn’t consist of blatant infractions such as surgeons throwing tantrums in the operating room. Instead it tends to be subtle: Sarcasm. Condescension. Passive-aggressive behavior such as not returning calls or pages, or belittling a nurse in front of patients and families.

It matters because patient safety is at stake when health care professionals can’t work well together as a team, Brown writes. And she issues a call for change to start at the top: “[A]longside uniform, well-enforced rules, doctors themselves need to set a new tone in the hospital corridors, policing their colleagues and letting new doctors know what kind of behavior is expected of them.”

As you might guess, the reaction to Brown’s opinion piece has been quite intense, especially from physicians who perceived themselves portrayed in an unflattering light. Uberblogger Dr. Kevin Pho called it “vicious” and “angry.”

“Attacking physicians so personally only serves to drive a bigger wedge between doctors and nurses, when in fact, we need to be working together to solve this issue common to both professions,” he wrote.

Some of Dr. Pho’s commenters thought it was little more than doctor-bashing. But others disagreed. “Should she remain silent?” one commenter wondered. “It would seem to some that to point out any flaws or faults in physician behavior is doctor-bashing. Is the preference to sit quietly and let the misbehavers figure it out for themselves – sometime after an incident comes to light when the behavior results in the death of a patient?”

A number of commenters shared their own stories of doctor-on-nurse bullying, nurse-on-nurse bullying, nurse-on-doctor bullying, nurse-on-medical-student bullying and other variations on the theme.

Other bloggers have weighed in here, here and here. Clearly the topic has struck a nerve – not only among health care professionals but the public as well.

My take? Brown’s essay didn’t come across to me as doctor-bashing, and it certainly wasn’t vicious. Rather, it publicly called out the culture that often silently allows such behavior to take place, sometimes at the expense of good patient care.

I doubt that bullying is rampant in the health care world, at least no more so than in other workplaces. Most studies, including one done here in Willmar a few years ago, suggest this behavior is perpetrated by a small minority. Yet there’s no denying it does happen, and some of the dynamics within the health care culture – the pecking order among professionals, the high-stress nature of patient care, perhaps even the type A personalities who often are drawn to the health professions – may contribute to and reinforce bullying behavior in ways not seen in other settings.

Patient care is filled with risk and complexity. It can’t be carried out well in an environment that’s hostile, unhappy and dysfunctional. Although it may be painful for insiders to see these issues publicly exposed, perhaps that’s what it takes to create enough pressure for all of this to start changing.

Previous entries on this topic: Eating their young; Health care professionals behaving badly.

4 thoughts on “Health care bullies

  1. As a nurse, I, too have born the brunt of ‘bullying’ by a doctor. I distinctly remember working with a doctor about 20 years ago who consistently would not return a patient’s phone calls. Each time he called for his test results we would attach a note to the front of his chart AGAIN and move the chart to the top of the pile where the doctor would see it. After more than a week of this, the patient finally made an appointment to see the doctor. When the doctor walked into the exam room, the door was not closed when he began yelling at the doctor and complaining because his calls had gone unanswered. The doctor’s reply? “I would have called you right away but the nurse never gave me your message. You know I would not have ignored you.” How angry was I? This was not the last in a long history of ‘being dissed’ by this doctor. I tendered my resignation shortly after this ‘last straw’.

  2. I worked for 25 years in the health care field and saw this happen many many times! It happened to me, a nurse. They were so mean/sarcastic etc. that I often wondered how those type of doctors treated their wives!!!!!

  3. Pingback: Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention « Nursetopia

  4. I am dealing with a dentist and dental assistant talk about close quarters! The really bad thing is that it seems to be ok to raise your voice and be mad as a doctor but as an assistant not responding,looking down, she is now put on notice due to not answering the rage of where is something so sad but so true! what do you do when someone is screaming at you? I think it is a no win so quiet is best. The poor patients!

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