In a New York Times op-ed piece (link here), oncology nurse Theresa Brown recounts a recent situation when a patient ”jokingly asked his doctor whom he should yell at” because a test result was late:
Turning and pointing at the patient’s nurse, the doctor replied, “If you want to scream at anyone, scream at her.”
…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 goes on to discuss what many regular readers of this blog know already, namely, that workplace bullying is a significant problem in healthcare and that nurses frequently are on the receiving end of it from doctors.
Brown’s op-ed is sparking responses:
Blame med school
Physician Kevin Pho, in his blog KevinMD.com (link here), acknowledges that bullying is a problem in healthcare but criticizes Brown for blaming doctors. Instead, he notes the prevalence of bullying among nurses and points a finger at medical education:
…blame should be directed towards the physician education system, rather than doctors themselves. The hierarchical culture that perpetuates bullying goes back as far as medical school, when as students, future doctors are trained in a pecking order not unlike the military.
Good point
Pho makes a good point: It begins in med school. Indeed, modeling and validation of individual behavior start during one’s socialization into a profession. Whether we’re talking doctors, military officers, lawyers, or professors, messages are sent early in one’s training about the “proper” ways in which to act and work with others.
Offender as victim
Physician Ford Vox, blogging for The Atlantic (link here) is less diplomatic. He suggests that Brown’s concerns don’t add up to a lot:
So in 2011 a New York Times op-ed blaming doctors for sparking negative hospital cultures is rather passé and makes you wonder what makes it worth running such a ho-hum opinion, especially on a Sunday.
He goes on to characterize her concern dismissively, referring to it as a “gripe” and taking issue with her “bland, well-worn generalization” about the status of doctors.
Ah, yes
And then Vox lowers the (predictable) boom:
What’s concerning and ethically dubious about Brown’s personal anecdote is its specificity.
Specificity? Huh?! Brown never identifies where she works, either in the text of the article or in the short bio line that follows.
Nevertheless, Vox elevates this into an ethical lapse because he was able to go on the Internet and find out where Brown works. He continues:
She gives enough detail in the column that many people at her hospital, especially “the entire medical team” present at the time, will know precisely whom she’s making an example out of. Using her platform at the Times, Brown just succeeded in royally bullying back the physician she’s just publicly accused.
Voilà!!! Vox manages to turn the offender into a victim and, in remarkable judo-like fashion, flips this into a question of Brown’s ethics.
Of course, had Brown not volunteered enough details to explain the context of the bullying situation she described, Vox might’ve criticized her for being vague and making a mountain out of a molehill. But as those familiar with workplace bullying know, context matters.
If I ever become a nurse, I sure as heck hope that I’m never assigned to Dr. Vox. He sounds like, well, a bully.
The good news
Think about it: A Sunday op-ed piece about workplace bullying in the New York Times, followed by responsive blog posts from the Boston Globe and The Atlantic. If you’re wondering whether the workplace bullying movement has gained traction over the years, this is evidence of its success.
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Bullying in healthcare
I’ve written a lot on this blog about bullying in healthcare. For a four-part series of posts on this topic, start here.
Also of possible interest
Nursing as a Calling: Aspirations and Realities
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Hat tip to Katherine Hermes, Connecticut Healthy Workplace Advocates, for the Vox blog post.
I’m a doctor in the UK who teaches medical students. I thought Brown’s piece was entirely appropriate. I am surprised and disappointed by both Kevin’s pieces. Individuals in a profession have to accept responsibility for their profession.
Thanks,
Anne Marie
Anne Marie, as a member of two professions (law, higher ed) that have their own problems with bullying, I agree! Thank you, David
Doctors who bully nurses and other coworkers “beneath them” in the pecking order aren’t always that great with patients, either, especially patients with multiple or difficult-to-treat conditions. Anyone who’s such a patient can tell you at least one story of a doctor who jumped to a conclusion without listening to the patient or cut short the patient’s questions.
Lisa, I think some of this does go back to communication skills honed (er, not) at the earlier stages of one’s career, in this case med school, residency, internship, etc. Add to that the time pressures of modern medical practice, and the reality that many people are drawn to medicine for reasons (often admirable) other than opportunities to be interpersonally engaging with others.
Thank you,
David
Having spent 15 years as an HR professional in health care facilities, I know of many instances of doctors bullying nurses, administrators, patients, etc. Unfortunately, whether those of us non-doctors realize it or not, SOME doctors have not yet realized that they are not God.
Not only do SOME of the male docs bully generally, SOME of them are also incredibly disrespectful in their operating rooms of the women on their teams as well as the patients on their operating tables.
There doesn’t seem to be anyone in a position of authority who is willing to take this travesty on in the individual hospitals. Well-known docs bring in patients and money. Nothing else matters.
Suing (and winning) doesn’t even seem to matter. If someone has a big enough name, he can just go to another hospital, city or state. His past transgressions are known by all — but he is not denied a job because of them — and no doubt is given more money in each new position.
Additionally — whatever happened to: If you don’t want someone to know what you did, don’t do it?
As you have already said, David, to villainize the victim is such a shallow and transparent response. What about the Truth of the first-hand experience?
Oh — I forgot — there is no such thing as absolute Truth…..
It has been interesting to follow the growing number of responses on the Internet. Apparently a lot of doctors are taking exception to Brown’s op-ed. I wonder if they are even moderately aware of the power disparities in the typical healthcare workplace!
David,
I think the docs who are responding negatively are the ones who are quite aware of the power disparities and they want to keep it that way. In fact, they see nothing wrong with the status quo.
[...] bloggers have weighed in here, here and here. Clearly the topic has struck a nerve – not only among health care [...]
People should respect others, regardless of what their job is. When I was a patient in the hospital, I always thanked the person who emptied the trash and mopped the floor. I treated them with just as much respect as I did the doctors and nurses, because they are people too!
Thank you for writing on this topic.
Mrs. Brown’s writing about bullying in nursing were a huge help to me when I was being told on a daily basis how stupid I was.
If we want to provide the best healthcare possible we ALL need to get on the same page and have respect for each other and the care we provide. No one person can care for a patients. Doctors need nurses and nurses need doctors as well as the mounds of other healthcare providers that are involved in the mix.
My mother always told me you get alot more flies with honey than with vinegar, and even though I’d rather keep the hospital free from bugs, I’d sure rather have the honey myself, and Im sure the physicians would too.
Bottom line, best respectful, treat others how you want to be treated, and put the patient first.
Thanks for this validation. Let’s not forget all the other front line healthcare workers that get abused on a daily basis: occupational therapists, physical therapists, nursing assistants, social workers, technicians, counselors, etc. Let’s also remember the medical hierarchy. I’m sure nurses get abused a lot, BUT they are 2nd to doctors in the chain of command. The highest in the hierarchy are least likely to be abused.