Why are so many doctors complete jerks?

As odd as this might sound, my mother was upset when I declared my intention to go to medical school.

It wasn’t the mountain of debt I was sure to incur since I’d already figured out how to get Uncle Sam to pick up the bill (a small deal that put me in a military uniform for a decade).  It wasn’t the fact that medical school would delay the litter of bouncing grandbabies she wanted to fawn over.  And it certainly wasn’t because she’d miss me—she’d already seen too much of me and my dirty laundry on weekends during college.

No, my mother was legitimately disappointed in me for choosing to enter the medical profession simply because she had a deep-seated disdain for doctors.  I could almost envision her sad disgrace as she chatted with the neighbors during my final year as a resident in brain surgery:

Mom: “What’s little Festus up to these days?”

Neighbor 1: “Oh he’s doin’ real good.  He’s got hisself a carwash business up in Magna that pulls in a couple hundred a week.  Lookin’ to buy a bass boat for him and the misses.”

Mom: “And Cletus?”

Neighbor 2: “Almost done with his ten years up at the state pen in Bluffdale.  Won an award for license plate stampin’.  Trixie and the boys are real proud of him.”

Neighbor 1: “And what’s Eric doing?”

Mom: “He’s still not married.”

My mother never told me why she disliked doctors so much.  I’m left to assume that she’d had a number of bad interactions with them over the years, but she never bothered to back up her expressions of disapproval with any sort of details.  It took several years for my mother to warm up to the idea that I had not turned to the dark side by becoming a doctor.  I think a lot of it had to do with inertia—by the time she finally decided to express any acknowledgement of my career decision, two more of us boys were in medical school and I supposed she realized she couldn’t be disappointed in all of us.

Now that I’ve been in practice a number of years I’ve finally learned what it was that so intensely turned my mother off about doctors: they can be arrogant, condescending and impolite.  Of course, many of my readers are at this moment wondering if I’m also going to reveal other mysteries such as “birds fly” and “dogs bark.”

I had a roommate in medical school who was a great guy.  He studied hard, didn’t party too much, and always managed to put the toilet paper on the right way (rolling out from the top down, in case you were wondering).  Years after we graduated and had gone our separate ways I had a phone conversation with a physician assistant who’d gone to work for my old roommate.  “It must be great working for Dr. X,” I added.  A pause on the phone.  “No,” he said slowly, “he’s a total jerk.  Everybody hates him.”

I have two theories.  One is that all medical students believe they will go on to become an Albert Schweizer in their field—kind, self-sacrificing, benevolent—but somewhere along the way a certain fraction of them let the glory of their career go to their heads and begin to treat patients and underlings like chewing gum on a movie theater floor.  What constitutes that percentage is in the eye of the beholder.  For my mother it was some where around the 98% mark.  I’m a little more generous—I’ll say 20%.

My second theory is that all doctors believe themselves to be noble, kind, and beloved by all.  Rarely do I come across an arrogant doctor who recognizes him- or herself as such.  Rather, almost all of us think we’re appropriately mannered.  And we are … most of the time.

The rubber hits the road, though, when job-related stress enters the picture.  A physician who ends up an hour behind in a busy clinic can become snappy at his nurses and receptionists.  A surgeon who is elbow-deep in a case gone awry will turn her anger toward the anesthesiologist and scrub techs.  In both cases, the doctors in question feel they were simply reacting appropriately to the situation: “Of course I yelled at my nurse.  Doesn’t she realize she is making me later than I already am?” or “Of course I hurled the Metzenbaums across the room.  Am I the only one in the OR who cares what happens to this patient?!”

As any nurse will tell you, the true measure of a doctor’s demeanor is not how he or she acts during times of ease.  Instead, the nature of a physician’s soul is uncovered precisely during those times when he or she has the most right to explode in a volcano of vulgarities and instrument-throwing.  A doctor who can keep cool while juggling 3 phone calls, a clinic filled with patients, and a patient exsanguinating on the operating table is both rare and worthy of high esteem.

In fellowship I had the misfortune to work under a cardiologist described by all other fellows thus: “She’s fun socially but awful to work with.”  This proved to be true: at a staff party she was great to have around, but when faced with the challenge of rounding on 15 patients in a two-hour period she transformed into Medusa.  Yet, I’m sure, if asked, she would maintain that she is polite, kind, and patient—as long as the situation doesn’t demand otherwise.  The problem is that her definition of “situation” was pretty much every day at work.

We doctors have chosen professions that are inherently filled with stress, deadlines, and treading in deep emotional waters.  None of that grants us a free pass to behave like spoiled toddlers.  As I see it, doctors should always follow 2 simple rules:

Rule #1: It is simply not allowable to be impolite, mean, nasty or snippy with staff or patients even when you are in a stressful situation.

Rule #2: Whatever is stressing you is probably stressing those around you as much or more.  Under those circumstances you have to go out of your way to be kinder and more understanding.  As a doctor, you control the mood in the clinic and operating room even if you can’t control the situation.

I freely admit I am unable to always adhere to these rules but I at least recognize them and intend to spend the rest of my career trying to do better.  My mother passed away many years ago but I’m hoping that somewhere up there she can look down and see that I didn’t turn out to be so terrible after all.

Eric Van De Graaff is a cardiologist at Alegent Health who blogs at the Alegent Health Cardiology Blog.

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  • Peter Elias

    The headline implies that there are more doctor-jerks than other-jerks. (The post itself doesn’t say this, of course.)But I can’t resist taking a poke at the headline.

    I don’t think that there are more doctor-jerks than lawyer-jerks, roofer-jerks, stay-at-home-mom-jerks, or teen-jerks. (Well, maybe there ARE more teen-jerks, but it’s a phase and many become human eventually…)
    I think that the role played by doctors makes their jerkdom more potent and more visible.
    Mind you, I am not saying it is ok for doctors to be jerks to the same degree as the rest of the world. I think the role we play in the lives of others demands (or should demand) that we hold ourselves to a much higher standard.

    • voitokas

      Perhaps the pressures of a doctor’s role make it more difficult to be graceful with others?

      • Olivia Morrissette

        Voitokas–the pressures of a doctor’s role? Too bad. We all have intense pressure in our roles.

    • NewMexicoRam

      Don’t forget the patient-jerks.
      My point: people are human. Jerkness must be somewhere in the genome with various expressions.

    • Olivia Morrissette

      Nurses who work with physicians would disagree with you somewhat.

      • Dr. McNinja

        That’s real funny, coming from a nurse. The meanest and cruelest people in the hospital, hands-down, are the nursing staff! Not even the meanest surgeon comes remotely close to the cruelty that myself, my classmates, and my friends at 5 other medical schools have experienced at the hands of nurses. There are enough hospitals we’ve rotated at, between myself and my peers, that I’m fairly certain our conclusions can be generalized.

        Nurses hold an incredible amount of power over med students and residents. And they make sure to go completely out of their way to make physicians-in-training absolutely miserable. We’ve been severely verbally abused by nurses who want to “put us in our place” (not sure what that is, especially since the vast majority of the time, my only mistake was to exist). We’ve been taunted, made viciously fun of. We’ve had nurses tell patients and their families, right in front of us, that we’re not to be trusted, that we regularly harm patients, that we’re lazy and incompetent, and that they knew more than all the doctors in the department (just screams inferiority complex). And they get away with it. They threaten to page us very late and constantly to make sure we get as little sleep as possible when on call if we ever try to stand up for ourselves. I have been shocked and appalled far too many times to count. When I entered the medical field, I expected that my residents and attendings will be tough on me. They turned out to be the people who best tried to protect me from the real jerks in the hospital — nurses.

        Keep in mind that this experience is a fairly common one. This isn’t some isolated incident — myself, my classmates, and friends at 5 other med schools (that’s got to be more than 20 hospitals between us — both community and academic) have had remarkably similar experiences. So, no, it’s not our physician superiors or their behavior that makes us hostile toward nurses. It’s the nurses themselves, who treat us so inhumanely for years on end! Don’t worry, I still treat them with utmost respect (my grades depend on me being “personable”, aka not stirring up trouble, on the wards) — it’ll be a very long time, though, before I trust them and view them as colleagues.

        • Olivia Morrissette

          Yes, Dr. McNinja, I’m afraid I have to agree with you. I’m sorry and embarrassed about it, but everything you say is true. A lot of nurses are small-minded and not very bright. I guess I’d call them meatheads, too. Basic nursing school is not that tough.

  • http://www.facebook.com/wayneyp Waynette Porter

    As a patient who routinely sees various doctors due to chronic illnesses, I try to realize that even if a doctor is snappy to me, it’s likely not because of ME. Unless we just don’t get along and then I try to end the misery for both of us and find a doctor I can work with. Having chronic illness means the doctor and patient need to work together for the best of the patient. Respect goes both ways; both parties have rights and both have responsibilities. Just as it is my responsibility to do my best to avoid taking my pain etc out on the staff and doctors who are trying to help me, it is their responsibility to do their best to avoid taking their stress out on me. It’s not always possible to do that. And I’m the type who, if I’ve had a bad day and haven’t been the easiest person to deal with, will try to apologize. I would hope doctors would do the same.

    I’ve had doctors I simply loved but had to stop seeing because there was so much stress associated with the visits because of the staff. I’ve had others that I went to once and because he acted like as a patient I shouldn’t know a great deal about my meds and conditions, I never went back. I am fortunate that the doctors that are most important to my care are wonderful. And some aren’t doctors even but are NPs.

    Spending 11 months in a hospital and then the following 2 years in a nursing home (at the age of 31-34) taught me quite a lot about interacting with staff of all types; doctors, LPNs, RNs, CNAs, student nurses, student doctors, student CNAs, PT/OT, radiology, phlebotomy, social services, dietary, housekeeping, maintenance, activities, chaplains, hospice workers (my roommate at the nursing home was on hospice and I got to know the hospice staff), volunteers, wound care, and I am sure I am forgetting people are all people I interacted with quite a lot in those 3yrs. And for the most part, even when it was obvious they were having a stressful day, most did their best to avoid taking it out on those who had nothing to do with the cause. That said, there were always a few that you knew when you saw them on the floor that you were not going to have the best day because you could tell they were having a bad day.

    It really goes both ways. I’ve been the problem patient for some staff just because I was in pain and while I didn’t mean to take it out on the person caring for me, I ended up making them upset. I’ve also seen how some patients, are so rude, demanding, picky, and selfish that even the best of staff members can go in the room in a perfectly good mood and come out steaming. In all honesty, I understood it as I felt that way when interacting with the person myself. The type of patient who would try the patience of a saint, let alone a stressed out, overworked, likely underpaid human. I was fortunate that I did not HAVE to deal with people like that, unlike the staff members. I tried to never be that way by being understanding when waiting 10-15 min for help with something despite my serious discomfort, by being patient when I had to wait because either another patient had a need more pressing than my need or who had called before I did. I even had times when a problem patient called for help after I did but I told the staff member to take care of the other person because I knew how we’d all pay later,

    We’d all get along better if we were a bit more apt to follow those two rules. If I am stressed about the lack of progress in my care, it’s possible a doctor is as well, depending on how long we’ve been trying and not having success and how long we’ve worked together. I know I’ve had doctors who felt their hands were tied and were frustrated because we were doing all we could and nothing was happening. Their frustration was not directed at me and was understandable. While the patient has more at stake in having successful treatment (it’s their body and no one else can feel the extent they are bothered by their illness), the doctor has a lot of time and effort involved as well. So a lack of success is frustrating and understandable. There are times frustration is directed at the illness yet both the patient and doctor take it out on the other party. It’s not fair, but it’s human nature. The key is communication, a willingness to take responsibility for your words and actions and to ask forgiveness when you’ve been cantankerous, annoyed or a big fat jerk face!

  • http://twitter.com/DeeRN livingheartbeat

    Can I offer a third theory? I think it’s lack of social supervision. Let me explain. First year residents know the expectations of fourth year residents and that nurses can be their lifeline from drowning. Rarely do you see an arrogant first year resident.
    Some hospitals have now adopted codes of conduct that require all staff’s behavior to each other and patients be appropriate and anyone, including doctors can be written up for infractions. In other places, without the CEO, Department Head or someone with the stature recognized as supervisory coming onto the floor, there are doctors who will behave as the “authority” of all.
    I would think this would hold true to other professions but in medicine I’ve seen it.
    I’ve seen the pattern broken by that one nurse who stands quietly, arms akimbo, waiting for the tantrum to pass before acknowledging the presence of, much less demands of a tantrum. This nurse will only respond or allow anyone else’s response when requests become reasonable. Cycles of behavior, now broken, begin to change.
    I think all of us are aware of our behavior at some level as well it’s effects on others and our responsibility for our own behavior. If it were not true, there would be no need for justifications “don’t they realize…” or “am I the only one….?”.
    Frustrations and stresses mount, yes. I think in medicine we should be aware that continuing bad behavior is partially the responsibility of us all. We have social standards and maybe should ask ourselves how much have we allowed these actions to continue? None of us function in a vacuum. We all have the ability to affect change and reward positive communication.
    The question is, why did we as a community let your mother down by allowing her to consistently have such bad experiences from us or our colleagues?

    • Brad White

      I completely agree! Doctors behave the way they do because they can.

      • http://twitter.com/DeeRN livingheartbeat

        Brad what I actually meant was because we (the medical profession) allow it.

        • Brad White

          Yup, still agree! That’s exactly how I understood you. Hospitals are afraid that physicians will leave and take their patient volume with them. As a result, they will tolerate extreme behavior. Are all doctors bad? Nope, some are retired. (just kidding, just kidding!)

    • LastoftheZucchiniFlowers

      I have always been fond of the phrase ‘arms akimbo’, meaning hands on hips with elbows turned outward. Is that what you are describing? Hospitals and their environs, AND their staff have changed in the last 25 years. Tantrums get you nowhere as most physicians-in-training are taught and know. The behavior you describe was once de rigeur but no longer tolerated without legal action ensuing.

      • http://twitter.com/DeeRN livingheartbeat

        Not being argumentative but I’ve been both metro and rural environs. The behavior lives, breathes, unchecked by legal, but the ability of some to catch up is another discussion I think.

  • http://www.facebook.com/lucy.hornstein.1 Lucy Hornstein

    Bottom line, in medicine as in everything else in life, frankly seems to boil down to this:

    Don’t be an asshole.

  • http://www.facebook.com/profile.php?id=1382989019 Eric Pierce

    The health care system is replete with predatory, corporate economic elements. That is the root of the dehumanizing behavior.

    There are far too many ultrawealthy people making big money off of other people’s suffering and deaths.

    Bias disclosure: I’m a middle age widower (single father of three minor children).

    • Olivia Morrissette

      Well, the health care system with it’s predatory, corporate economy is part of it. The larger part, however, is persons whose cognition, emotions, and impulse control are askew.

  • http://twitter.com/NCBeernut Scott

    This is a really easy one – a lot of people in general are jerks. Given the nature of a physicians work, we are just more critically evaluated by individuals and the general public.

    • http://www.facebook.com/alittlebooboo Adriana Sabatini

      Given the nature of physicians’ work, they *should* be more critically evaluated for their behavior and bedside manner. It’s much more traumatizing to be belittled by someone while your legs are in the air and your bits are privy to all those present than it is to be belittled by someone who has no control over you or your health.

    • Olivia Morrissette

      Dr. Van der Graaff isn’t talking about people in general. He’s talking about physicians who decompensate under stress and lash out at at colleagues who have less social power then they do. They do this because they lack character. I’m an RN, and I see these guys.

      • Dr. McNinja

        I wonder what you’d say about nurses who treat med students and residents like absolute crap even when they’re not stressed out. How much character do they have?

        • Olivia Morrissette

          Yes. I’m a registered nurse, and I agree with you completely. And do you think the worst of these nurses are empathetic and proactive toward their patients? They are not. I’m very sorry for the way they behave toward you med students, and I apologize for all of them. Some of us out here love working with med students, love our patients, and are decent to everyone. I hope you get some of them, too.

  • http://www.facebook.com/vivek.rana.967 Vivek Rana

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  • EmilyAnon

    I hope for your mom’s sake you finally got married.

  • LastoftheZucchiniFlowers

    Eric – the attitude you describe is due in large part to the way your mom’s generation of physicians were trained to view their patients and themselves. It was not that long ago that the cartoon of the surgeon rushing imperiously past the line of good souls awaiting entry at the pearly gates looking questioningly at St. Peter with the caption”…Oh, that’s just the Doctor, he thinks he’s God!” featured prominently in the New Yorker. I findi many of today’s newly and recently minted (within the last ten years) physicians to have FAR LESS misplaced hubris than my age cohort and that is a good thing. The new kids are no less bright, but far more realistic in the job they do and what they expect from the populations they serve. My age group (ready to retire now) entered the field during the chaotic years of change between DRG, the onset of ‘managed’ care and pre-authorization. We saw our fathers and grandfather’s practices thrive as complete monarchies where THEY were KINGS and patients/hospital administrators and their staff all bowed obsequiously. Somewhere along with way the pendulum had to swing back to center where I believe it is today. There will ALWAYS be jerks and social imbeciles among our ranks as in all professions. However in today’s litigious environment, they won’t endure. I’ll bet your mom has softened some in her views.

  • StephenModesto

    …Thank you for sharing your thoughts and reflections of daily experiences. The well suited corporatte `rainmakers’ and the temperamental rock stars make the money which drives the machine. Personal `styles’ are often tolerated for lengthy periods of time…even when nursing staff can document `situations’ to medical directors and to the hierarchial structure of hospital nursing administrators. Ironically, their professional abilities and seeming personal success are not always directly correlated to an authenticity of human understanding and consideration of that process of sharing human life…Similarly, these are things not easily taught in school even if a few `classes’ are thrown into a progressive curriculum. The incongruency is only more pointed when those instances are within the lives of MDs.

  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for this post Dr. Van de Graff. I agree with your two rules AND they are impossible to live up to 100% of the time. They are based on two things that most doctors are never taught to do in med school and residency.

    - Be aware of your feelings and stress level and know how to release them
    - Take good care of yourself so you have reserves of energy and compassion for your patients. Yo can’t give what you aint got … so get your needs met.

    These two skills should rightfully be a core component of all medical education. With them under your belt … your two rules become MUCH easier to comply with.

    My two cents,

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • drseno

    Wow, Dr. Eric. You have a lot of feedback from your awesome story. You hit a nerve. Here’s to say — your sweetness made me smile and laugh.

    Your mom was cool.

    I’m happy to know you, that you’re out there trying, teaching and modeling how to ‘be.’

    Isn’t it awesome for you, your colleagues and patients, that you can affect people’s well being this way? Thank you.

  • Candace Reeves

    Forgive my rant and cynicism in advance but this is my experience: I believe that most of the people who become doctors do so just because they want money, power, and prestige. The majority of conventional doctors I have seen in the past were arrogant, condescending, inept drug pushers basically telling me that I was fine or that I was a hypochondriac just because they were too incompetent to understand what was the cause of my problems (problems caused by their so- called medicines in the form of the Gardasil vaccine) and I didn’t want any drugs. The day I found naturopathic medicine was the best day of my life!

  • HemlockHouse

    Great essay, Eric, and the comments are fascinating too.
    Jerks abound in our society, not just within the medical profession. We have become a rude, demanding, self-entitled, impatient society. Read “Talk to the Hand” by UK author Lynn Truss for an amusing review of the deterioration of social behaviors. Also, Bob Sutton, a Stanford professor wrote an interesting book called “The No A$$hole Rule.” I have reviewed his website and even e-mailed him regarding a difficult, narcissistic, arrogant colleague. I am embarrassed when I encounter or hear stories about jerk-docs. Those of us that are kind, patient, humble and honest do exist. I wish there were more of us. Dealing with health matters is serious business! I do not understand why some docs are rude, impatient, cocky…we should treat patients as we would want to be treated, we must know our limits and know when to ask for help with a patient, OR if we are burned-out/struggling.

  • Bruce Dennis

    Well said Kevin. I’ve noticed that my colleagues who too frequently lose their cool rationalize that they are being effective teachers. Maybe the harsh and critical demeanor of some medical school professors teaches us that this dysfunctional response is helpful. Angry, disruptive docs often perceive their colleagues or staff as incompetent or unintelligent when they don’t respond well to this intense and inappropriate communication. A tough problem for a medical staff or office. Harsh words to a patient often reflect some previous experience they have encountered such as a lawsuit or loss of a patient. I’ve never found confronting a colleague with complaints or feedback to be very productive, but I have seen some physicians mellow with age. Your favorite mild mannered and kind physician may have been a bear to deal with when he was younger and less confident.