Bullying is a problem within health care.

Stung by a physician’s rebuke, Theresa Brown, an oncology nurse, takes to the op-ed pages of the New York Times to address the issue.

In it, she cites several vignettes that paint doctors poorly:

But while most doctors clearly respect their colleagues on the nursing staff, every nurse knows at least one, if not many, who don’t.

Indeed, every nurse has a story like mine, and most of us have several. A nurse I know, attempting to clarify an order, was told, “When you have ‘M.D.’ after your name, then you can talk to me.” A doctor dismissed another’s complaint by simply saying, “I’m important.”

Clearly, there is no excuse for the behavior described. Nurses are essential to the health care team, and on KevinMD.com, there have been numerous pieces praising nurses, and how doctors can’t function without them.

But does Brown goes too far, when she blames the entire medical profession as the root cause of health care bullying?

… because doctors are at the top of the food chain, the bad behavior of even a few of them can set a corrosive tone for the whole organization. Nurses in turn bully other nurses, attending physicians bully doctors-in-training, and experienced nurses sometimes bully the newest doctors.

I’m not sure that physicians, although certainly not guilt-free, should bear the sole responsibility for a corrosive culture that pervades some hospitals. For instance, it’s well-known that bullying is prevalent within the nursing culture. Shouldn’t they bear some responsibility as well?

Instead, 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. It’s no wonder that some carry that attitude into the workplace. Of course, that’s no excuse, but changing physician behavior needs to start at the beginning, not in the hospital after they’ve been indoctrinated.

And finally, a comment on the piece’s inflammatory tone. Theresa Brown is a contributor to the Times’ Well blog, which, if you read the comments, has an audience generally less than friendly to physicians. The op-ed panders to the hostile physician sentiment of Well’s core readers, and while sure to be popular, is regrettable.  Brown has a prominent media platform in the New York Times, and in a way, she wields it here to metaphorically bully the entire physician profession. Perhaps her workplace environment is particularly toxic, but the doctors I know harbor nothing but the greatest respect for nurses and the rest of the medical staff. They don’t deserve to be painted with such broad strokes as was done here.

Bullying in health care is a real problem, and needs to be addressed. But this vicious column strikes me as angry, and is also unfair to many of Brown’s fellow nurses, who have collegial relationships with doctors.  Attacking physicians so personally only serves to drive a bigger wedge between doctors and nurses, when in fact, we need to be working together to solve this issue common to both professions.

Update:
I wrote a follow-up piece, on Doctor bashing, and confronting physicians in the media.

This essay is cited in the KevinMD record on violence against health care workers.

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 Facebook, Twitter, and LinkedIn.