Bullying Wars: Theresa Brown vs. ‘the entire physician profession’

By Maureen Shawn Kennedy, AJN editor-in-chief

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.)

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Editor-in-chief, AJN

9 Comments

  1. […] Bullying Wars: Theresa Brown vs. ‘the entire physician profession’ « Off the Charts. […]

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  3. […] Bullying Wars: Theresa Brown vs. ‘the entire physician profession’ AJN‘s editor-in-chief Shawn Kennedy comes to the defense of nurse and author Theresa Brown, […]

  4. Lois Roelofs June 24, 2011 at 2:31 pm

    My female internist told me the same thing; she had horrific stories about the attendings. As a nurse, rather perversely, I was “almost” happy to hear it! But, of course, it’d be so much better if we could all behave according to the Golden Rule.

  5. Girl June 23, 2011 at 11:40 pm

    Bullying in hospitals happens at all levels. Resident physicians often experience bullying by the attending physicians, nurses and technicians and resident colleagues. It is where they learn how to fight bullies most often by becoming one. In medical school, it starts in the clinical years but it most prominent during residency. Speaking from experience here!

  6. Lois Roelofs June 20, 2011 at 12:16 pm

    I wish you well. Sounds like a very disheartening experience.

  7. Are you kidding? June 19, 2011 at 9:21 pm

    I am currently in the process of negotiating for a Unit Secretary position in my own unit after working for more than 25 years in ICU: because: one doctor criticized me, then another, then another all within maybe a 3 week period and my boss said that I had to “dig deep.” But she didn’t say where to dig deep to. I need to keep my benefits, and in this economy to keep my job, and I have been working part time in order to reduce the hours of work “exposure,” if you get my meaning. My point being, right or wrong, you cannot fight against physicians: you can only be brave and take what managment wants to dish out or quit.

  8. Alexandra O'Brien June 3, 2011 at 10:47 am

    This issue of bullying and interdisciplinary team member relationships in general is also well addressed at some length in Suzanne Gordon’s book, “Nursing Against the Odds.” In particular, Gordon stresses the harm that can be done by an atmosphere of intimidation and hostility that can prevent organizations addressing problems. The examples she mentions include the Bristol Royal Infirmary, UK, and a similar pediatric cardiology program in Winnipeg, Canada, in which nursing staff felt either unable to warn of the incompetence of an MD or, in the Canadian example, were ignored despite attempts to draw attention to such incompetence, leading to the unnecessary deaths of many children.

  9. Lois Roelofs June 1, 2011 at 10:13 pm

    I agree with “Spare me, please.” I’m retired now (from teaching nursing), but several of my past experiences mirror Brown’s. I thank her for putting the issue “on the table” once again. I hate, however, that it’s still on the table. My first experiences of being put down by doctors occured over 50 years ago. It’s very discouraging that a need remains to address it.

    I’ve written about a few of my experiences in my new book, Caring Lessons, and, when I give readings, invariably lay persons’s mouths will drop open if I read one of those parts. They say they “never knew” such stuff went on and wonder aloud how we’ve put up with it. So I’m happy Brown’s article has generated awareness once again.

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