Abuse and Power

This study (PDF here) from an outfit called The Physician Executive Journal of Medical Management tells us what we all know too well: poisoned relations between nurses and physicians, specifically and mostly consisting of the latter abusing the former, but also sometimes the other way around, is bad for patients.

What was the most common complaint? Degrading comments and insults that nearly 85 percent of participants reported experiencing at their organizations. Yelling was second, with 73 percent. Other typical problems included cursing, inappropriate joking and refusing to work with one another.

Some of described behavior is criminal, and would appear to meet the criteria for an assault charge, such as throwing scalpels or squirting a used syringe in a co-worker’s face. But according to some survey participants, it’s the day-to-day putdowns and slights that can be the most harmful.

“The worst behavior problem is not the most egregious,” wrote one participant. “It’s the everyday lack of respect and communication that most adversely affects patient care and staff morale.”

Another float in the Parade of the Blindingly Obvious.  But now — hurray! —  we have a study, instead of the avalanche of nursing anecdotes we all have been repeating to ourselves since Flo was emptying bedpans, but all ignored because, you know, we’re just a bunch of whiny nurses.

A few things caught my eye. The cases of physical assault were striking. Having scapels thrown at you, or getting your head stuffed down a garbage can by a physician is, as the study points out, actual criminal assault. Don’t care if Dr. Obnoxious was having a bad day, or his wife left him, or his last three patients developed post-op nosocomial infections — things which another article in the same issue charmingly and evasively calls “acute stressors.” I would be curious if any of these physicians were ever charged with assault, and if not, why. I think the answers would be revealing.

Alas, the study — nor the related articles in the same issue — doesn’t quite address the underlying causes of abusive behaviour. Well, almost. From the same study, here’s a clue:

study1

So in other words, though physicians account for the most instances of bad behaviour, nurses are the ones that get in in the neck.

Speaks volumes about the power differentials in your average health care setting, doesn’t it? And just maybe, there’s an unexamined relationship between power and abusive behaviour?

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  1. #1 by Art Doctor on Tuesday 05 January 2010 - 1643

    Maybe naive of me to speak to this, but I seriously find it disgraceful that Doctors treat Nurses so poorly. It must not be all Doctors, but it is certainly an eye-opener for future MDs to be more cognizant of their interpersonal communications with Nurses, and in bedside manner.

  2. #2 by Maha on Wednesday 06 January 2010 - 0008

    Do you think the doctors’ ages might have something to do with it? Or do you think the abusive relationship patterns are passed down to each new generation of doctors? I find that some of the old school doctors (nearing retirement age, if not already passed it) can be a lot more condescending to the nurses than the younger set. I’m lucky to work with (for the most part) a really great team of docs but the few really old generation ones can really make me feel like crap.

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