On May 11, an op-ed piece written by nurse and New York Times blogger Theresa Brown on bullying by physicians caused some physicians to protest (full disclosure: Brown’s honest and moving ethical meditation on a very different topic, “Right Treatment, Right Patient?”, was just published in our June issue).
Notable among her critics was Kevin Pho of the popular blog, Kevin MD, who wrote that Brown “unfairly blames doctors for hospital bullying.” He claimed that Brown uses her writing outlet to “metaphorically bully the entire physician profession.” Another commentary (by physician Ford Vox, writing in The Atlantic Monthly) accused Brown of publicly “drawing and quartering” her colleagues.
Spare me, please. Brown used a recent personal encounter to illustrate a problem that is, unfortunately, commonplace in hospitals. She used it as a lede and parlayed the story into an insightful piece about bullying in hospitals. (From experiences I had and witnessed during my clinical years, I actually thought it was a fairly mild example.) Ironically, the strong language used to counter Brown’s commentary made it seem that physicians were trying to bully Brown into silence because she’d spoken out. As if to say: how dare a nurse challenge physician behavior?
Brown didn’t lay all the blame at the feet of physicians—she acknowledged that there’s plenty of nurse-to-nurse bullying (see our article on this published in 2009, which is still among our most widely read). And we know there are plenty of bullies in the workplace—in 2005, we published research on disruptive behavior by both nurses and physicians and the detrimental effects it has on clinical outcomes (nurses and physicians were comparable in the frequency of disruptive behaviors). Bullying has been such an issue that in 2008 the Joint Commission issued a sentinel event alert on the dangers of bullying and announced a new standard (which became effective in July 2009) for “zero tolerance” of bullying.
After the early, defensive posts, Kevin MD took a more conciliatory tone with an article published last week on FoxNews.com and offered suggestions for mitigating bullying behavior. He quoted Harvard medical student Ishani Ganguli, who noted in a post on WhiteCoatNotes that “curriculum should be expanded to teach medical students how to interact with nurses more collegially as team members, rather than as part of a superior–subordinate hierarchy.”
This gets to the heart of the matter. When students learn dysfunctional communication patterns (for example, a medical student observes a senior physician belittling a nurse for questioning a medication dosage, or a nursing student sees a competent staff nurse afraid to speak up to correct a physician-ordered treatment), the patient loses. Poor communication is at the root of many medical errors. Even if no error occurs, the patient loses the collaborative thinking of educated professionals, all committed to her or his well-being. And as professional colleagues we lose something too: respect for each other and respect from our patients, who too often witness the bad behavior . . . and suffer because of it.
(Editor’s note: Not to beat a dead horse, but this week yet more useful context has been added to the conversation on this topic by a pediatrician who writes the PopRX column on Salon.com and by an interview with Brown at Pulmonary Central.)