The following column was published on May 28, 2011 in FoxNews.com.
Theresa Brown’s New York Times op-ed, Physician, Heel Thyself, recently introduced hospital bullying into the national health care conversation.
In it, she recounted a hospital vignette while working as an oncology nurse. A patient asked a doctor who should he blame for a late test result. The physician, turning to Brown, said, “if you want to scream at anyone, scream at her.”
That type of boorish physician behavior certainly cannot be tolerated. Brown was brave to bring hospital bullying to light in a national forum.
But soon after her piece was published, many physicians, including myself, were defensive as Brown essentially singled out doctors for the bullying that goes on in hospitals.
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“Because doctors are at the top of the food chain,” she wrote, “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.”
But I wonder if the issue is more complicated than simply blaming physicians. Most doctors I know harbor nothing but the greatest respect for nurses, and realize how important they are to quality patient care. It seems unfair to tar them with such a broad stroke.
And besides, others in the hospital are responsible for bullying as well. Like nurses themselves, for instance.
Last year on Well, the Times’ health blog, Brown herself wrote that “overwhelmed and angry nurses take their frustration out on the rest of us stuck in the corner with them, or on anyone they perceive as being less powerful than they are.”
Indeed, 60% of new nurses leave their first position because of bullying from their colleagues, such as verbal abuse or harsh treatment.
Brown calls for changes up top, such as hospital administrators adopting uniform standards of professionalism for every staff member, no matter how important they are, and having offending parties undergo civility training.
But those policies are already present. University of Pennsylvania bioethicist Arthur Caplan, in response to Brown’s column, points out that “hospitals are instituting courses about bullying, reporting systems are increasingly in place, and punishment is happening.”
Instead, change also needs to occur from the bottom up. Consider how physicians are educated.
The culture that perpetuates bullying can be traced as far back as medical school, when as students, future doctors are trained in a pecking order not unlike the military. During the first two years, medical students have little exposure to patients and are exposed to the hierarchical tendencies and behaviors of their professors.
This needs to change. Medical students need to learn, from the beginning, how to work as members of a team. They need to understand that patient care is not only about the doctor and patient, but about how doctors, nurses, and medical assistants form a cohesive unit for the singular goal of helping patients.
That’s beginning to happen at some institutions, like Harvard Medical School, where patient care concepts are introduced in the first year. Harvard student Ishani Ganguli, writing in the Boston Globe’s health blog, says “through role play and interviews with volunteer patients, we learn the vocabulary, even seating positions, that allow us to take detailed histories from patients and show empathy for them. We carry the skills from this course with us through subsequent years of medical school and no doubt beyond.”
She makes a point that such a 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.
Hospital bullying is often shrouded in silence, and Theresa Brown should be applauded for publicizing the issue. But targeting the toxic culture that perpetuates the problem requires everyone to share responsibility. Not just doctors, but nurses, hospital administration, and medical educators as well. Only when every stakeholder is part of the solution do we stand a better chance of eliminating bullying behavior in hospitals altogether.
This essay is cited in the KevinMD record on violence against health care workers.
Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.
He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.
Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.
