Doctor bashing and confronting physicians in the media

Doctor bashing and confronting physicians in the mediaIt’s certainly been fascinating monitoring the response to Theresa Brown’s New York Times’ op-ed on physician bullying.

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:

  1. Theresa Brown should be applauded for bringing up a difficult topic in the Times
  2. Hospital bullying exists among doctors, nurses and medical students and needs to be exposed
  3. 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.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitter, and LinkedIn.

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  • http://www.wishfulthinkinginmedicaleducation.blogspot.com Anne Marie Cunningham

    Kevin,

    I’m a doctor who has commented and was not outraged by Brown’s writing. She was not attacking doctors. She was saying that you and I have to take responsibility for our profession. And nurses have to take responsibility for theirs. This is the very basis of professionalism.

    Shirking this responsibility does a profession no good at all.

    Anne Marie

  • http://www.parentingintheloop.com Lorette Lavine

    Thank you for this post…

    Doctor bashing will go on because of the frustration with the healthcare system.

    Perhaps …we should be focusing on the root cause.

    Root cause is difficult to find…perhaps we should be looking at the malpractice issue which puts everyone on the hot seat when something actually goes wrong and it will go wrong because we are all human.

    Blame will make people act in defensive ways and actually become hostile towards each other…just look at the “Celebrity Apprentice”….they eventually eat each other at the end.
    There is also a issue with the education of nurses…there are many ways to get an RN…Associate Degree, Bachelor Degree…then there are Masters Prepared nurses. Make no mistake…education does make a difference. Doctors all have the same basic education, nurses do not.

    So doctor bashing is the easiest way to confront the current system…well if it continues you will see the quality of medicine deteriorate and it will not be about “physician heal thyself” it will be about “patient heal thyself”.

  • http://drsamgirgis.com Dr Sam Girgis

    Bullying occurs everywhere. If you look at medicine, there is a very well defined stucture of hierarchy – from medical studen, to intern, to resident, and up to attending. This structure of hierarchy goes up to the chair of the department, and ultimately to the CEO of the hospital. Because of this hierarchy, there are some individuals who will use their seniority to their own benefit. If it’s done in a way that’s inappropriate, bullying may result. We must recognize this, but not accepted it complicitly.

    Dr Sam Girgis
    http://drsamgirgis.com

  • JPB

    There is more to this than meets the eye. For me, the core problem is that there is no way to challenge/criticize doctors, either as a fellow professional or as a patient. You will get bashed by the MD’s no matter if you complain publicly or privately.

    If that nurse had confronted the doctor publicly at the time of the offense, she would have found herself very quickly without a job. As a patient, if you question your doctor’s orders you will find yourself without a doctor.

    So what’s the answer? What do you say to a physician who pulls the “you didn’t go to medical school” line? This apparent inability of doctors to accept any questioning or criticism is a big part of our medical industry problems….

  • http://twitter.com/phlu phlu

    Kevin,

    I appreciate your perspective on this issue. There’s a difference between critical engagement and bashing, and I personally believe she’s more in line with the former than the latter. Furthermore, the medium of the Op-Ed tends to lead to drawing brighter lines, which means that some of the worthy themes she and you raise in your pieces might not get fleshed out as much as we would like.

    Toward that end: in both this piece and your initial reaction, you make a point of saying that a good amount of the blame can be placed on medical education. I agree: the “hidden curriculum” certainly contributes to creating a culture in which bullying can both thrive and become a behavioral norm.

    But, if anything, I’d argue placing the blame on medical education puts the responsibility for creating a culture of bullies even more squarely on the shoulders of physicians themselves. After all, the bullying culture would be occurring under the oversight of the attendings, who are responsible for the students (and the resident-teachers) during the clinical rotations where these behaviors are taking place. They also would be the people responsible for creating the culture where medical students might (or might not) feel comfortable raising concerns should unprofessional behavior be directed toward them.

    I’m not saying you’re wrong, but isn’t that even more damning than any criticism Ms. Brown might be be directing toward any one particular doctor for being a bully?

  • westeasterly

    I really wouldn’t agree with “indisputably wrong.” It sounds to me as though the physician clearly intended humor that was lost on this nurse who was looking for something to blog about. There are many attempts at humor that occur each day that would sound horrendous if retold a certain way online, out of context, from a single perspective, by someone with a vested interest in making something out of nothing.

    • Anna

      It’s a universal tactic of the bully to claim “You just can’t take a joke.”

      Ms. Brown strikes me as highly-educated with a keen and subtle mind. I believe she is quite capable of discerning the difference between a joke and a slam designed to demean and belittle.

      Let’s assume for the sake of argument, that bullying in the medical profession exists and is harmful to patients. Now – what do you want to do about it?

      • ninguem

        Sorry, I read it the same way as (apparently) westeasterly. She described the patient as joking, I read it as the doctor joking back.

        Being highly educated does not mean she’s able to discern ordinary interactons. The best example of that are the doctors themselves, supposedly unable to discern when they’re hurting feelings despite their own high education.

        • Anna

          You may be right. Hard to know in the context of the story that Ms. Brown recounts. A lot can be gleaned from tone, as well as context, so it may be that the tone of the doctor’s response was not joking. As we know, bullying by and among medical professionals exists. It seems not unlikely that Ms. Brown has experienced bullying in her time as a nurse.

          Would you disagree?

          More importantly bullying by and among medical professionals, including nurses, harms patients.

          What do you propose to do about it? What can you do in your own institution to reduce bullying and increase effective patient care? It’s not about the doctors or the nurses. It’s about the patients. Let’s not forget that.

          • ninguem

            “It seems not unlikely that Ms. Brown has experienced bullying in her time as a nurse.”

            What makes you think the doctor has not experienced such bullying?

            What would I do?

            Remove the immunities of peer review. Remove noncompetes from medical employment contracts.

          • ninguem

            True story.

            There’s an old joke. “What’s the difference between an intern and a pile of sh!t? You don’t deliberately step on a pile of sh!t.”

            I once had a nursing supervisor go out of her way to tell me that story. She didn’t like me. Fine.

            My response was to thank her. I had acceptances to residency programs. One was the hospital of my internship. One was another place. As it turned out, I actually had the letters in my pockets. I showed them to her.

            I told her I will go elsewhere. I told her when the chief of service asks why, I’ll tell him. “I’ll mention your name and our little conversation today”.

            Given that I wanted to finish the program, and knowing that they can and do try to torpedo your future, I actually did not do that…….at that moment.

            I did, about five years later, when the same chief wanted me back as faculty.

            I told him I would not go there under any circumstances, for any money, and I told him why, and then I did mention names. The nurse was some VIP’s wife, I doubt anything would happen to her.

            This works both ways. I know it does, having seen it, having experienced it.

            You know full well it happens in any other human organization on the planet. Why anybody would think that human medical organizations should be any different from any other human organization is naive at best.

            But I can tell from the responses here, and other sites, the fact that I have seen it happen to me, the fact that I have seen it happen to others, is irrelevant. Minds are made up.

            I don’t even know why I bother mentioning this, it just makes me the bad guy. Again.

          • Nerdy but not a clinician

            OK, so you experienced it. But you also perpetrated it, and thus the cycle continues.

          • ninguem

            Nerdy – so you experienced it. But you also perpetrated it, and thus the cycle continues.

            If you’re directing that to me, in what way did I “perpetrate” it [bullying or abuse]?

          • Nerdy but not a clinician

            You ratted her out, not in the spirit of trying to improve the organization but to get even. And I apologize if I have misunderstood your motives, but that seems to be what your story is conveying: “I’ll mention your name and our little conversation today.” You may not have said it at the time, but you stored it up and, wham! – when the opportunity came along five years later, you used it as a weapon. That is a bullying and intimidation tactic.

          • ninguem

            Nerdy but not a clinician – “That is a bullying and intimidation tactic.”

            Well, there you go. It says it all. You call what I did bullying and intimidation?

            I was the injured party. I responded by walking away. I chose to do my training elsewhere. I chose to train at a better place. What I want through was characteristic of a sick system. The hospital in question no longer exists by the way. I was an intern. Interns have absolutely, positively, completely no power in the system. None. The nurse in question was a nursing supervisor, and the wife (girlfriend, concubine, I forget now) of a VIP in the hospital. You think the intern is going to be able to do anything about it. That’s rich.

            I did my part, such as it was, to improve the system, by informing someone who did have power. Though I suspect the individual did not have the power to do much either. Yes, years later. I’m such a bully. I suspect the nurse supervisor was no longer there anyway by that point.

            By your way of thinking, if I treat a patient badly and the patient takes his business elsewhere, the patient is bullying me.

            If I were sexually harassed and reported the harasser, I’m a bully. “Ratted her out”?

            Actually, you’ve described what the docs can experience, perfectly. Damned if you do, damned if you don’t. A doctor (intern) with no power, bullied by a nursing supervisor with power. The power inequality is 100% against me. I leave an abusive situation, afraid to say anything for fear of retribution, and finally said something years later when I was approached by the same hospital to come work for them, otherwise I would have continued to keep my mouth shut. I was no longer at risk………

            ……..and you have the nerve to claim it’s my fault.

            You know……and you wonder why doctors are arrogant.

  • ninguem

    She also mentions “when the nurse is a bully”

    http://well.blogs.nytimes.com/2010/02/11/when-the-nurse-is-a-bully/

    I know I’ve been on the receiving end of this bullying. I had a postop patient once, acutely out of the operating room. Nurse didn’t like me, I found out later due to a misunderstanding ON HER PART. She thought I had said something that someone else had said. She decided to slander me. I ended up with a quality assurance complaint. I had abandoned a critically ill patient.

    Review of her own nursing notes showed me at the bedside the entire time. Entry after entry. “Dr. Ninguem at bedside”, “Dr. Ninguem did this”, “Dr. Ninguem did that”. “patient awake and responsive”, and then I left, and patient did well. The furthest away I had been was to use a sink to wash my hands, that thing doctors supposedly never do.

    I asked the chief of staff investigating the complaint, what he was going to do about staff just flat-out lying to hurt someone. Writing a QA complaint that I wasn’t there, and writing nursing notes that I was there. She has to learn to lie better. All I got was mush from the medical staff, and the chief of nursing, about how THE DOCTORS need to watch out about how WE are perceived.

    In other words, the nurse lied about me, and it’s my fault.

    I’ve learned it’s a waste of time trying to defend myself over things like this. It’s clear from reading responses, people have made up their minds already.

    My response, my only way to defend myself, is to remove myself from any hospital work. Not just the dollars and cents of it, I find the atmosphere hazardous to my professional health.

    Actually, the biggest bullies were suits in administration.

    • Vox Rusticus

      The appropriate response is to file a grievance against the nurse who wrote falsely about you; she is no more entitled to use the procedures of her workplace to libel or slander you than she is anyone else. Accusing you falsely of abandonment without cause is defamation and abuse and if true, deserving of censure and punishment.

      • ninguem

        My protest was getting me labeled as “disruptive”.

        I was beating up on a girl.

        http://www.physiciansnews.com/law/1101.html

        I agree it was “defamation and abuse” as you say.
        I agree that “if true, deserving of censure and punishment”.

        But the way peer review works in reality, the complaint goes nowhere. Bias and base vengeance against the targeted physician don’t matter in a peer review setting.

        And the courts don’t care. The lawyers say that. Here’s a law review article on that very subject.

        http://www.semmelweis.org/ref/080z.pdf

        I mean, I appreciate the sentiment, and I agree with you. But listen to the comments here. The bullying goes both ways. Their minds are made up. Downright lies, an agenda to deliberately hurt someone, and it was being construed as my fault.

        And that’s not the only such story I can tell.

        As a practical matter, my remedy is really to leave all hospital work completely.

        And people wonder why primary care doctors won’t do hospital work anymore.

  • Vox Rusticus

    “I couldn’t believe that this doctor, who had always worked well with the nurses on my floor, had just suggested, at least in my mind, that a nurse’s opinion on patient care matters less because patients don’t directly make appointments with us.”

    Eloquently written or not, her disbelieving or not, she provides exactly the reason why her opinion might matter less in “her” patient’s disposition, First, she doesn’t bring the same knowledge to the patient as the patient’s doctor, and second, the patient sought the doctor’s opinion.

    Ms. Brown certainly has a right to disagree with the doctors with whom she works. But she does not have the right to presume her differing opinion is of equal value to all of the other opinions that are relevant to the patient.

    Her account of that patient’s suffering should not lend her any authority, and she is no more correct in assuming she made a correct call against continuing therapy just because the patient suffered as a result. That is the patient’s call, not hers, and it is the patient’s right to decide to take the chance on a course of treatment when offered, even when it means a potentially painful and unsuccessful outcome.

    Being part of a team does not mean everyone on that team has an equal voice. Not every player is the quarterback. Ms. Brown doesn’t seem to understand that, nor does she seem to understand that lots of other people beside herself share the role of patient advocate.

    • Tetris4

      “First, she doesn’t bring the same knowledge to the patient as the patient’s doctor, and second, the patient sought the doctor’s opinion.

      Ms. Brown certainly has a right to disagree with the doctors with whom she works. But she does not have the right to presume her differing opinion is of equal value to all of the other opinions that are relevant to the patient.”

      Thank you for saying this, Vox. As a patient, I want somebody on my healthcare team to act as leader, and I want that person to have the most knowledge and experience.

      Last year my husband and I decided we wanted a third child, but we weren’t sure if it was a good idea with a chronic illness I have. I talked to my GP and she thought things looked good but ordered a consult with a maternal-fetal medicine specialist. The MFM specialist gave us the go-ahead with a medication change.

      To my shock, I got a call a few days after the consult from my GP’s nurse. She told me that she knew what the MFM doc said but that she herself didn’t agree and that we “shouldn’t really have any more children.” I was so angry I could barely speak–this person had taken blood from me once, and taken my temp twice. And she was going to disagree with a specialist’s evaluation? I was nervous about a third pregnancy (which is why I sought the consult) and it was terrible to have my trust in the doctor undermined.

      I talked to my GP about the incident and she was very unhappy about it and promised to discuss boundaries with the nurse. The nurse is still at the doctor’s office–and she sometimes weighs the new baby.

      • stitch

        Thank you for your story. I have seen similar issues myself although primarily in the inpatient system. This is, to me, an example of the nurse taking empowerment too far and interfering in the care plan, even to the point of being unprofessional. She had no business giving you her opinion, especially and particularly if it was a personal one. That is not her role. It is fortunately not a common occurrence but should not happen at all, for exactly the reason you mention: it interferes with your relationship with your physician.

  • Dr Chris

    What I see here, and on the floors, is a horrible dance of passive aggression that can go on between doctors and nurses.
    It is guaranteed mutually assured distraction.
    Just a thought.

  • http://drpullen.com health blog

    Why is a blog like that of Ms. Brown not a “bully pulpit” of her own and her’s just a different kind of bullying. It looks like there is no one really taking the high road in this drama.

  • David MD

    I have rarely been provoked to write on blogs, but this Op-Ed in Sunday’s NYT was stunningly inappropriate.

    I did the math. Dr. Brown looks to be in her early 40s, did a PhD in English and was on faculty somewhere as an English prof, afterwards she took some time off for kids and then went to nursing school. She’s had then, maybe 2-6 years of actual RN experience taking care of patients? But she has no qualms in questioning whether a patient should be getting chemo or not. See http://well.blogs.nytimes.com/2010/10/13/how-far-should-a-nurse-go/

    Dr. Brown hit a nerve among MDs, in that we’ve all been appropriately lectured to death about PC interaction with RNs, patients, and other health care providers – but are exquisitely aware of the antagonism we put up with on a daily basis (depending on the hospital and unit where we practice) from RNs and other healthcare providers. So such a one-sided attack in a major newspaper has caused a significant reaction. Just read the evolving comments on the NYT blog, particularly those from the medical trainees. She’s virtually assured herself an audience for future blog posts – and it won’t be a friendly one.

    Dr. Brown blatantly ignored the role of hospital administrators, including nursing unit administrators, in setting the tone of MD-nurse interactions. Different hospitals or even individual units in the same hospital can exhibit widely disparate behavioral cultures and medical standards, a tone that is set in large part by the nursing unit and hospital administrators in charge. A lax environment allows for the kind of nursing behavior Ms. Brown discussed in her prior piece on “When the nurse is a bully”, http://well.blogs.nytimes.com/2010/02/11/when-the-nurse-is-a-bully/ Alternatively, a well-run unit or ward emphasizes collegial and respectful interactions between MDs and nurses, in addition to aggressive compliance with the appropriate medical and nursing standards of care. So physician-nursing interactions such as those described reflect just as badly on the culture and standards of the nursing unit and hospital (UPMC Shadyside) in which Ms. Brown practices, as they do on the MDs who have the misfortune to work with her there.

    The anecdote in her story didn’t ring true. I don’t think it’s a coincidence that Dr. Brown chose an incident in which she was completely blameless. It was particularly odd to me that she informed the MD that she’d write about him. Sort of a “nice reputation you have there, it’d be a shame to destroy it”. But from reading her past blogs this is evidently her M.O.; she writes in her other blogs about asking for permission to write about MDs, sort of a journalistic informed consent. This time, though, I expect she’ll be in deep do-do at her day job, I can’t imagine UPMC Shadyside being overly happy about seeing their dirty laundry exposed to the world. I would also assume that she has violated her terms of employment at Shadyside.

    Frankly, it beggars belief that an academic attending, who evidently knows about Dr. Brown’s extracurricular writing, would be so stupid as to act this way out of the blue. Yes, I know nothing of the working environment in the Oncology ward at UPMC. Chances are that this attending is repetitively inappropriate. But for all we know, he might be the eminence grise of the whole unit, beloved by all – but annoyed to distraction by repeated antagonism from Dr. Brown. Just from the tone of her blogs, my sense is she must be an absolute nightmare to deal with.

    • ninguem

      She got her RN degree in 2007, so all this expertise is based on a little over three years experience as a RN.

      • stitch

        Thank you for that information. I went back and re-read some of her posts with that in mind. One would hope that experience would give her some more perspective, but agendas tend to preclude that.

  • Mary

    I have worked 20 years as a physician and can tell you that nurses can bully us. There is quite a lot of research on nurses and the way they. One such study found “Female doctors often find that they are met with less respect and confidence and are given less help than their male colleagues”. I am sure there is enough bullying on both sides, nurses tend to use passive aggressive means due to their level in the medical hierarchy but can be good at undermining their female doctors. There is nothing stopping these nurses from going the hard road to a medical degree. My female colleagues confirm they all have been bullied and undermined by nurses simply because we do not meet the Marcus Welby, traditional Female/Male model.

    Time for everyone to respect each other for the value our variety of skills bring to the healthcare system. Bullying is NOT acceptable no matter if perpetrated by physicians or nurses. Just recognize that nurses are also capable of bullying fellow nurses and physicians. as one friend of mine who is a nurse told me “Nurses eat their young … I have observed bullying by nurse on nurse. Let the truth be known.

  • Sue Woods

    This is one doc that agrees with both of you. I want consumer/patient voices praising AND raging. Fine with me. Solutions need to be wide and deep, though. Every hospital organizationally sequesters it’s doctors into “Medical Staff” and “Nursing Staff”. Things work the way they’re designed. So while medical/nursing school change is essential, gains will be lost in the workplace if leadership structures don’t change.

  • http://Buddhishmd.blogspot.com BuddhishMD

    There is good that evolves out of these conversations and that is to think more about bullying behavior in general, what it’s root caused are and real world solutions. Bullying is anger expressed & happens when we react rather than respond to deep seated needs for power & control (that have there own causes another layer deeper). The answer is, I think, to stop blaming & finger pointing & look to our own behaviors and ask the tough questions. I relate one solution to mindful practice at buddhishmd.blogspot.com

  • David MD

    Many of you may be interested in the responses to Ms. Brown’s previous blog piece, “One nurse, one patient”, since many of the responses concern the doctor-bashing Op-Ed. In addition, the piece is an interesting description of rather significant medical mismanagement.
    http://well.blogs.nytimes.com/2011/05/04/one-nurse-one-patient/

    • Oda MD

      Wow, her knowledge base is scary.

      “The drug, called Rituxan, stimulates the immune system to release chemicals called cytokines, the same thing that happens when someone gets the flu. ”

      No, it’s a monoclonal antibody that binds to and removes CD20 cells.

      Either going to medical school or checking the wikipedia entry would have educated her to that simple fact. Those with a little knowledge are the most dangerous. She acts so important but doesn’t even know what a 3rd year medical student should about the drug she’s giving.

      • OptimAge

        Spot on!
        I have a nurse who says Ringers Lactate will jack up a person’s glucose. I have nurses who believe that pulling down on an obese person’s chest will improve a larygoscopic view… I’m doing my best to teach them w/o bullying (sarcasm), and I’m getting better at it. It’s actually more fun and keeps me on top of things.
        What I can’t cure though is lack of overall situational awareness in an OR environment; all linear task completion and waiting to be told, for even the most obvious next step.

  • http://drpauldorio.com Paul Dorio

    Although I posted on this topic yesterday,

    http://drpauldorio.com/respect-is-a-two-way-street-a-comment-on-phys

    - it is obviously of interest to many of us who work in the healthcare system. So here’s another comment:

    Two wrongs don’t make a right, as they say. If the bully is allowed to continue, he/she will. If, however, a person looks that bully in the eye, it is possible that a brief discussion might alter future behavior.

    For example: “I was quite hurt/insulted/put off/etc by your flippant comment. You may not even have realized that you were being so insensitive. Could you please consider my feelings next time because the comment you just made made me feel quite belittled?” (In Ms Brown’s scenario I’d have attempted such reconciliation outside the patient’s room and in a private discussion so as to maximize the potential for the doctor to not feel threatened and therefore perhaps respond appropriately)

    In my experience, most people in work situations don’t take the time, for whatever reason, to bring their issues to the person involved. Administrators tend to get pulled into the mix instead. In untenable, persistent situations, that’s what they’re there for. But what might happen if we tried to communicate more openly and honestly with each other? That’s something I espouse and ask of others. And it works.

    In most instances it’s all about how we treat each other. In Ms Brown’s scenario, obviously there was one who was the bully and one who was belittled. But if the bully is made aware of his/her actions and their consequences, at the adult level I would hope that such behavior could be corrected.

    If not, then by all means, lash out in the press with vitriol.

  • http://Buddhishmd.blogspot.com BuddhishMD

    The desire to lash out “with vitriol” is understandable but as someone who has done so countless times can attest this does not produce anything more than a transient surge of self-righteous energy that rapidly dissolves into wondering whether I could do better the next time. Getting folks on the defensive (the result of lashing out) does not seem to be all that helpful in actually helping things to change. If i start by understanding WHY someone exhibits bullying behavior, usually rooted in their own feeling of inadequacy and low self esteem (who has lower self esteem than someone who brags? Inner wisdom never feels like bragging) then I am less reactive back. Understanding dissolves anger, once anger is gone then i can make a clear choice of how to respond to bullying behaviour – and although there is no “one way” to respond one possibility is to state what it was about the other persons behavior that I found offensive and why i found it offensive and ask the other person if that is what they meant and if so then why. It is easier said than done to have that much equanimity but it is an intention to keep aiming for, over and over again.

  • HdHawk

    So sorry to hear your defensive response to Ms. Brown. There, of course are many ways to present this issue, but instead of taking cheap shots at Brown for how the material was presented, you would have done more good by taking the high road and addressing the issue. The fact is that the problem is so pervasive that the Joint Commission found it necessary to issue a Sentinel Alert about it. Disruptive behavior in the medical work place results in harm to patients, who after all, should be at the center of your thoughts, as opposed to the bruised egos of the doctors.

  • http://mdhealoneself@blogspot.com Dr Adjoa

    I was so irritated when I read this article last wk. It’s so typical to the petty and devisive behavior of nurses on the floors and sure when that doctor responses by saying, ‘blame it on the nurse’ he was lashing out based on prior intersections with her. Nurse are the biggest bullies in medicine they often have an inferiority complex when dealing with all physicians they treat female doctors like my self even worse. Kevin the nursing training not medical school is to blame for facilitating this adversarial culture. I’ve had to write up nurses in a few cases of this. Dealing with nurses is one of the reasons why I avoided practicing in hospital medicine

    • Mary

      Thank you for your comments. As a female physician I have been sabotaged and bullied by nurses. They especially resent women who do not go into the ‘pink’ occupations and have had the fortitude to go through Medical School. Women are the worse in targeting women who are successful.

    • Jason M

      Dr A. I agree. I have observed many nurses undermining and harassing (mostly through passive aggressive behaviors) female doctors. Add ethnic minority or ‘foreigner’ to the mix and the vitriol becomes astronomical.
      For some reason, female nurses hate to see other women in professions of higher status (due to years of acquiring higher knowledge). They feel they have to do a one-up-manship of female docs. Ms Brown obviously feels that her PhD and having her name preceded by ‘Dr’ gives her the same expertise (and status) in the medical profession as her Dr. title gave her in her other profession. Sorry … it doesn’t work that way.
      I am tired of nurses who are ‘wanna be doctors’ lashing out at physicians and bullying them because they achieved a skill and knowledge level the nurse was not willing to invest in time and effort.
      Most nurses are decent, cooperative, hard working individuals but unfortunately a few bad apples have upset the apple cart.
      Unfortunately, these are the signs of our times. Our society fosters people wanting positions of power and authority without the necessary skills or knowledge required to Lead. It is our ‘fast food’ mentality’! Too bad we don’t have ‘drive by’ medical schools they can go to.

  • http://www.parkinsonsummerschool.com Paul de Roos

    Dear All,

    I’m a junior doctor working in the field of neurology, whom spends his evening hours often thinking and reading on medical education and training.

    I appreciate the courage of Theresa Brown, a health professional daring to speak up on what bugs her in public. The fact that it arouses debate tells me that however inappropriate perceived her message, it hits a sensitive spot. When a sensitive spot is touched.. there’s usually a reason for that.

    We need colleagues daring to put their career opportunities at risk to spark the discussions that will unlock us from status quo and open space to reform and thinking differently.

    For me the finger pointing/interpretation of what happened is trivial. In my humble opinion in the end it boils back down to our medical education:
    We are taught well to memorize, yet not to cope with change
    We are taught to take responsibility, yet we are not trained to be leaders.
    We are supposed to work in a team, yet we are trained to focus on “personal excellence”.
    We are trained and socialised in particular patterns of thought which we call clinical reasoning, yet the problems we face in every day practice require creativity for solutions. Training in creativity was not particularly part of the medical curriculum.
    We are trained to solve medical problems, yet we find it hard to solve real life problems (beyond medical symptomatology).
    We know to bring our car back to the dealer when it’s broke, yet we are trained to continue working when the hospital is broke (just shut up.. and do your work, there are more patients waiting! or are you unfit for practice?).

    Concluding: Bullying/Burn out/loss of empathy/drop out of professionals and suicide among professionals, are in my opinion all end points of education gone wrong. Our education is not training us appropriately to deal with the harsh realities of professional life, yet most professionals survive (surviving is not equal to joy). I’m not speaking for the nurses here as I know most about medical education, yet I do know that also the nursing training has quite some problems in these aspects.

    Best regards,
    Paul de Roos, MD

    • Mary

      Sorry to disagree. Creativity and interpersonal skills are not something that can be taught in medical school or any other school for that matter. Life teaches you these skills. I do not need some professor telling me how to treat other human beings, this is a no brainer. One has to take personal responsibility for their actions, behaviors, and character.
      Perhaps the problem is that medical and nursing schools do not know how to weed those with narcissistic personality traits/disorders from being accepted in the first place.

      An elementary school child can tell you it is wrong to mistreat others and know that they are being bullied or they are bullying. The character and skills are developed at a young age as studies show that children that are bullies grow up to be bullies and often end up in jail due to their aggressive behaviors.
      I think we need to stop blaming it on the Medical Schools wanting them to be our nannies. Medical schools are supposed to screen for leadership traits in their admissions and if we have a lot of physicians lacking true leadership, the screening process has failed because leadership is a lifelong skill attainment.
      did Mahatma Gandhi, Martin Luther King, Mother Theresa have to be ‘taught’ leadership?

      • http://www.parkinsonsummerschool.com Paul de Roos

        Dear Mary,

        Thank you for your response. It gives me the feeling that my post is read, which gives it at least some purpose beyond trying to give some constructive input on the sad low level of this total discussion, which is a disgrace for our colleagues.

        The shape of our disagreement is 1) a nature/nurture perspective: can it be trained at all – e.g. steepening this lifelong skill attainment learning curve 2) a “when to learn” statement where you state this would be learnt earlier in life or during life 3) you suggest that a medical school should screen for leadership traits and that they should carry this responsibility and further not bother to try to train us as your opinion seems that this cannot be done there.

        If you appreciate a response on your statement. This is for me an easy way out as scientific literature to which I can point you if you appreciate it has quite some work done on these topics and I happen to have read much of it. Also with regards to training, I can tell you that businesses spend quite some money on it. They tend not to do this if there’s no return on investment. In healthcare we are not talking about that.. we talk about a patients’ health(!). I wouldn’t want a poorly performing team to take care of me in a (medical) emergency situation. I rather have the best possible team on earth and I want these teams to exist next to where I live. This gives one an agenda for activism ;-).

        With the knowledge we have today we may actually be able to equip people with the skills to be a Mahatma Gandhi, Martin Luther King or Mother Theresa.. yes, we can.. but, being one is hard and the sense of purpose and commitment comes from deep within. So it’s about connecting this sense of purpose and commitment with the skills and we create more of them. Our world needs not one Mother Theresa, we need thousands.. same goes for the others.

        Especially in healthcare there’s many people with this potential, but the skill to shape the system in a way around them to make them shine in their sense of compassion is not something they bring to their work quite often.

        Once more a thank you for your response. If you would like to share more thoughts, feel free to get in touch through twitter: @paulderoos

        • Mary

          Thank you for your counter response. I appreciate your point of view but I speak from experience. As a corporate physician for Fortune 20 companies over 15 years and being 59 I can tell you from experience that it has to do with ‘character’ and not training. I have had many executive training course, as part of my position, over the years and watched many coworkers with similar training be provided with same training – Conclusion: it still boils down to character, integrity, and motivation and how people treat each other. Those who truly aspire to possess leadership qualities will pursue knowledge and growth on their own by reading, research, etc.

          You sound young and idealistic, I commend you for that. Your character will determine if you will be a good team member, leader, achiever. Good luck to you.

          • http://www.parkinsonsummerschool.com Paul de Roos

            Dear Mary,

            Thank you! I hope I will have a different experience by time I reach the age of 59. I will note in my google agenda for 15-5-2038 to reflect on your words and see if my experience is similar.

            I try to understand what you mean with “character”: With these executive trainings e.g. the ones of Franklincovey on the 7 habits by Steven Covey (just as an example as there are a multitude of such models), I’d think that your understanding of character may be the qualities in people whom have strong sense of their own values in every day work (please correct me if I’m wrong). I believe no leadership training makes sense if you don’t connect it to your own sense of purpose and values. Now many people working in healthcare become detached from those due to the disruptive circumstances.

            A very nice talk on TEDxMaastricht on this topic was the one by Simon Sinek: “First Why and then trust” : http://www.youtube.com/watch?v=4VdO7LuoBzM

            If one works in a toxic environment in which people lose their dreams in face of the harsh reality of poor work-life balance, rough work hours, lack of sleep, toxic management, a very hierarchical work place etc. etc. it’s easy to lose all of that.

            As being only 31 years old and, young and idealist. It’s part of my “off duty” mission to train my peers in the skills they need to keep their dreams alive, when transitioning into this work environment. I dedicate quite some of my time when off work, to training and coaching those whom already showed leadership skills in (e.g. in international students’/professional activism).

            It’s from that perspective and my engagement with medical education during my student life that I wrote my replies. I see little miracles happen in people around me and that’s what gives me hope and it fuels idealism indeed, no matter how harsh reality is sometimes.

            Best regards,

            Paul de Roos

  • suzanne

    I was looking on line for incidents where patients have been victims of bullying by physicians because I have. I relate to the ways that doctors have treated nurses in a condecending manner. What I have experienced has been incomprehensible. The experiences I have had have been minimized and there has been no accountability which has given permission to the ones causing this treatment to continue.

  • Kathesw

    I have been a nurse for over 30 years, and have experienced and witnessed physician bullying for most of those years. I have witnessed a physician throw hot coffee on a nurse who was on the phone with another physician, when the bullying physician did not feel he had been responded to fast enough. Penalty for physician? a private apology. I have had physicians belittle me in front of patients and other nurses, as well as try to bully me into performing procedures and tasks beyond my scope of practice
    (a little anesthesia anyone?). Research has shown that bullying physicians are less likely to be called by nurses for questions on medications, to report changes in condition, etc…it hardly needs to be said how this can put patients health care in jeopardy. Fortunately, hospitals, and indeed other physicians are less tolerant of physician bullies and I see this behavior less and less. My son is a physician, and I hope I never hear that he has behaved unprofessionally to a nurse, a lab tech, or even a member of the housekeeping staff.

  • Mary Kemen, MD

    As a medical professional who put career, income, the whole enchilada on the line over this very issue of physician arrogance and greed, I feel I can discuss this with some depth of experience. I left a practice after twenty years over issues of partners berating patients, nurses, fellow physicians. I have also worked for the past ten years on revising the bylaws of our medical staff and helping nurses deal with physician behavior.
    There is no question that a certain percentage of doctors strike out at people whom they consider subservient, be they patients or hospital employees. It is irrelevant whether this stems from residency training, elitist perceptions, or pandering by hospitals. The real questions are have we been willing to acknowledge this within our ranks and, if so, what have we done to police our fellow offenders? Ms Brown has every right to bring this to the public’s attention because we physicians have turned a blind eye to this problem. We should be alarmed at the possibility that 7% of respondents in a survey indicated they would rather risk a medication error than question a physician! Where is our responsibility to “do no harm” by first treating every colleague with basic human respect?
    It does not matter if most doctors are respectful and professional. We are ALL responsible for dealing with the disrespectful, unprofessional, dangerous practitioners in our midst. Until we are willing to do so in a systematic fashion, we cannot be surprised if patients are quick to sue or or colleagues complain in public forums. We provide them no alternative to address poor physician performance.
    Ms Brown is correct that belligerent or arrogant physicians tend to respond more amicably to other physicians. Instead of tolerating this dual standard, we fellow practitioners need to institute behavioral codes within our hospitals and practices, and make them stick.

  • BuddhishMD

    Treating others as objects (as occurs in bullying behavioral) results from forgetting how are all interconnected. Why do we forget this (at times) ? – when we feel threatened and overwhelmed and/or have come to see the world as stratified into those who are “for” or “against” us. In any area (as in medicine) where there is pressure, high expectations, and a power differential this kind of bullying behavior emerges. Rules can help limit it but fail to address the root problem that is not understanding the harm being done to self and others with these aggressive behaviors. Addressing the root problem is simple but not easy – training and continued practice in mindfulness based medicine (or mindfulness based anything really, -eating, -relationships, -etc…) reveals the problem (the objectifying of others) & simultaneously is the solution – simple, but not easy – But what other choice is there really, mindlessness?

  • Mary

    Mary Kemen.

    Totally concur. It is not about training physicians Leadership as I do not believe you can train empathy and compassion. I agree that such behavior should be written into hospital by laws and ethics boards. Physicians who violate these should be SANCTIONED by the Board(s). The only way to stop bad behavior is through the right incentives.

    I will say that as a female physician doing my Internal Medicine in the 80′s, I and the few female physicians that were in the program where harassed by these same types with AXIS II diagnosis (big Egotistical/Narcissistic types that was attract to Medicine because of the status the profession would give them) – back then, no one knew about ‘hostile working environment’ or sexual harassment. Back the, nurses liked having females in Medicine because we didn’t treat them like some of our male counterparts. We had a collegiate relationship (except for some ‘wanna be doctors’ resentful of some women daring to take the leap i the 1970′s).

    Today, having so many women in medicine has changed the environment. Instead of being support, many nurses treat female physician with less respect and in some cases undermine, sabotage, and bully.

    If you are writing by laws for a hospital, this needs to be addressed … that not only prohibits physicians from bullying and being disrespectful to nurses but also nurses must provide the same level of respect and support to female physicians as they do to males. Bullying can take many forms from sabotage, slander, and other passive aggressive behavior. I suggest bringing in an organizational psychologist to help put the program and training together and provide clues to subtle bullying and harassment.

    Good luck!

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