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.
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.