Predictably, most physicians were outraged, while the rest of the population generally supported Brown. As alluded to in a comment, whenever you have an aggrieved party accusing another one in a national forum, controversy is what you’re going to get. The piece was the most e-mailed article yesterday from the Times, and hospital bullying is now part of the national healthcare conversation.
Let me first clearly state a few things:
- Theresa Brown should be applauded for bringing up a difficult topic in the Times
- Hospital bullying exists among doctors, nurses and medical students and needs to be exposed
- The doctors in Brown’s piece acted like jerks and were indisputably wrong
My issue is Brown’s methods, by pitting a wronged nurse against arrogant doctors. It’s a narrative that physicians will lose 100% of the time, no matter how they respond. Brown is a former English professor, and it’s no wonder that the framing of the piece is masterful.
But I wonder if taking such an adversarial approach would really help. Sure, it forces the topic into the limelight, but like firing a nurse who makes a fatal medication error, will simply blaming doctors for bullying solve a more systemic problem?
Yes, there are some doctors who are asses and treat nurses poorly, but from my experience, most aren’t and realize how essential good nurses are to patient care. As I alluded to previously, there are issues with how doctors are trained and educated that contribute significantly to the problem.
Ford Vox, in The Atlantic, quotes University of Pennsylvania bioethecist Arthur Caplan, who says,
… shaming one’s colleagues draws attention Caplan says, but does little to cure the culture. As Caplan points out, hospitals are instituting courses about bullying, reporting systems are increasingly in place, and punishment is happening. “If you want to improve the culture then narratives have to be drawn carefully to protect personal and institutional anonymity,” Caplan told me.
Precisely. To take a line from Dr. Vox, how will “drawing and quartering your coworkers in the Sunday New York Times,” change the culture of bullying in hospitals?
Brown’s solutions, which includes bureaucratic culture change up top, are fine. But she neglects to say that change needs to start down below as well, from the time students first step foot in medical school.
Finally, there is the issue of “doctor bashing,” which some feel this piece falls under. Physicians are easy targets. Spend some time reading comments on the Times’ Well blog, or even here on KevinMD.com, and there is no shortage of vitriol aimed at doctors. And, no doubt, there are some doctors who deserve to be punished and called out. It’s endemic of the frustration that many have with our health system.
But realize that most physicians do their best under impossible circumstances. As Brown herself states, buried at the end of her piece, “most doctors are kind, well-intentioned professionals, and I rarely have a problem talking openly with them.”
Confronting physicians in the media, as Brown does, is low hanging fruit. Doctors often cannot answer charges publicly, and those that do are going to be on the short end of public opinion. For instance, I’m fully aware that the majority of comments sure to follow won’t agree with me and will support Brown.
Adversity makes for great publicity, and from that standpoint, Brown should be commended for bringing hospital bullying to the forefront.
But while using doctors as media punching bags strikes a populist tone and makes everyone feel better, whether it does anything to confront the systemic issues at the root of most health care problems remains in question.