When Nurses Write About Physician Bullies, Don’t Shoot the Messenger

Theresa Brown has taken some heat for the op-ed she wrote for the New York Times last Sunday. When she wrote about her experiences being bullied by a physician and the detrimental effect bullying has on patient care, the reaction from MDs was angry and defensive. I am beginning to think, after reading though all the posts and comments, that her real sin was being a nurse challenging physician authority. Ford Vox, writing at The Atlantic took particular umbrage at a physician being called out at Brown’s work place. “Drawing and quartering your coworkers in the Sunday New York Times,” he wrote, might be run-of-the-mill for politicians. I’d like to see something better out of doctors and nurses.”  While making a very slight nod to the issue of  bullying behaviour among physicians, Vox’s principal objection to Brown’s article was the ethics of making an example of one particular physician; he went to an exceptional effort at demonstrating the physician could be identified — at least by his co-workers — by a Google search (and in the process outing Brown’s place of work, which at least one commenter construed as an act of bullying itself.)

Kevin Pho was somewhat more even-handed. But still, while acknowledging that bullying is a serious issue — which Vox trivializes as a “workplace spat” —  he accuses Brown acting in bad faith, of pandering to an anti-physician audience and “metaphorically” acting as a bully herself; he also engages in a tu quoque argument that nurses in general are bullies themselves. “Shouldn’t they [i.e. nurses],” he asks rhetorically, “bear some responsibility as well?” (Except that we do. Endlessly. Do physicians in the same way?)

The message, in any case, from our physician colleagues, is that nurses should shut up. We should not be airing our dirty linen in public. Any mention of physician bullying will only serve to exacerbate poor nurse-physician relations. It’s unfair to single out physicians. We aren’t bad actors ourselves, we treat nurses with the utmost respect, ergo, nurses should acknowledge the physician bully is a singular creature, as unique as a butterfly in a Toronto January. Et cetera.

I beg to differ.

I don’t think it’s quite true that physician bullying is rare and out of ordinary, even now, despite assertions to the contrary. When I thought about it, I realized without too much difficulty I could list dozens of examples of physician bullying, that I have been subjected to or witnessed, some dating from the dark ages of the late 1990s. These range from the utterly appalling — like the ED physician who unfairly and angrily blamed the primary RN for the death of a septic neonate, in front of the parents — to the half-humourous, some of which I have documented on this blog. I’m pretty sure nurses reading this could come up with a similar list.

Stating that some physicians bully, and that it is a more widespread problem than physicians themselves suppose, is not to take away from the respectful and collegial relationships I enjoy with the vast majority of the physicians I work with, but rather to address the reality of the complex power relationships in the hospital pecking order. It isn’t physician-bashing to point out the obvious. In any case both Vox and Pho ignore the central point in Brown’s piece: that when physicians bully, patient care suffers. It suffers because nurses are understandably reluctant to deal with a physician who will demean them. Who wants to call with a high blood sugar in the middle of the night, or question an inappropriate medication order, if you’re pretty sure you’re going to get reamed out in the process? It suffers because it’s a large factor in determining quality of nursing work life: poor nursing morale results in poor patient outcomes.

So there are some very good reasons to point out this behaviour out. Should have Brown been so specific, even if anonymously so? Both Vox and Pho complain vigorously about Brown’s lack of discretion in her account of the incident. My only thought is that their reaction is a bit over-dramatic, because the only people witnessing the inappropriate behaviour were the care team and the patient — and they don’t have to be told who the bully is. Further, I guess if Brown is as careful as most health care bloggers, she’s disguised the identity of the physician in question by changing details and artful misdirection so that it would be difficult for even employees of her institution to make identification. And I’ll add a small artistic quibble: a direct, concise, personal example is worth a thousand words of exposition. In the event, I’m not clear where the appropriate place would be to deal with it, except publicly and openly.

Bullying is an exceedingly frustrating issue for nurses, mostly because of the sense of powerlessness. When you’re subjected to the bullying, you feel like a target, and helpless to boot — and you can only respond with difficulty because the power relationships within the hospital hierarchy. In short, physician-bullies, like bullies everywhere, get away with it because they can. Nurses have been complaining about bad physician behaviour since Florence Nightingale disembarked at Scutari. You would think, that after 150-odd years of politely asking physicians to pull up their socks, they might take the issue to heart and engage in some real collective self-reflection on the issue.

It was encouraging to see this in a few of the comments to all the posts, amid all the palpable anger toward Brown. But she only put to words what every nurse knows. The physician reaction to complaints of inappropriate behaviour has always been to minimize, to scorn, to condescend, to trivialize, to redirect, or to deny. Kevin Pho points out, correctly, that hospitals are beginning to address the issue through workplace respect programs. But in all seriousness, how many physicians have actually been called to account in any meaningful way by these programs? Pho writes, in another post on the subject that, “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.” True enough. But despite this, it’s also true that nearly 100% of the time bullying physician behaviour will go by without serious consequences. The question I would like to pose to both Vox and Pho — and all the angry physicians out there — is this: have you ever witnessed a physician bullying a nurse, and what did you do about it?

Their answer, I would guess, would be, “Yes, and nothing.” I would be gratified to hear otherwise.

So physicians, stop complaining. We’re merely pointing out bad behaviour. It’s up to you to fix it.

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  1. #1 by Aurelia on Thursday 12 May 2011 - 1151

    “The physician reaction to complaints of inappropriate behaviour has always been to minimize, to scorn, to condescend, to trivialize, to redirect, or to deny.”

    Yep, that basically sums it up for patient complaints or complaints from fellow staffers. The doctors I have most respected are the ones who admit their faults and practice humility. They are rare. And i treasure them.

  2. #2 by AJ on Thursday 12 May 2011 - 1153

    Agree, and furthermore: physicians who bully nurses also bully patients, and there are even fewer consequences for that behavior.

  3. #3 by deBeauxOs on Thursday 12 May 2011 - 1200

    This is a very important issue. It should be pointed out that those physicians who use bullying tactics in the work place do not only behave aggressively towards nurses. In the absence of the latter, they tend to bully their patients and also those perceived to have a lower status than they do in the hospital’s hierarchy.

    I wonder if this problem is addressed in Med schools?

  4. #4 by Terri C on Thursday 12 May 2011 - 1601

    Oh for mercy’s sake, doctors got worked up over THAT little example? I’m sure everyone has seen worse–if the author got escalated responses over that one, I can’t imagine what whe’d have received if she documented worse–sheesh.

  5. #5 by cna training class on Thursday 12 May 2011 - 1704

    I guess there are bullies in every profession and thank goodness for the courageous few that are willing to shine the light on the issue and not merely putting up with the bullying like most do

  6. #6 by Dr. Val on Thursday 12 May 2011 - 2006

    This is an interesting and complicated issue… I do wonder if gender issues play a role in some of this? If the physician were a woman and the nurse a man, would the same thing have happened? If that changes the equation in any way, then there may be more at play than we think.

    I have to admit that male nurses have been kinder to me over the years (on average) than female nurses… and when I was a young doctor I had the sense that the nurses saw me as “guilty until proven innocent” of being a jerk. It’s possible that they had “PTSD” from arrogant and unprofessional doctors like the one in the NYT article… but my sense was that the male physicians weren’t digging themselves out of the same hole (they were more likely to be presumed innocent). I’m nervous to share that so honestly here, but I wonder if it’s worth a gentle and understanding discussion? Just out of curiosity… do female nurses feel that female doctors are more likely (on average) to be unprofessional or bullies?

  7. #7 by cartoon characters on Friday 13 May 2011 - 0939

    I have seen almost daily examples of bullying by MDs since 1977, when I started nursing. Everything from throwing instruments at nurses (and yelling) in the OR to actually laying his hands on the nurse when the MD didn’t like what was going on, to calling names in front of the patient…etc. On and on.

    I was never so glad to get the job I am in where we have NO MDs to answer to. That in of itself makes my work pleasant. I have to say, though, we still do get the occasional MD that tries to contact us to bully. They don’t get very far….because we can warn them and hang up on them if necessary.

    I have actually told an MD – in a hospital situation – that if he dared touch me, as he did the other RN…. he would be dealing with it in court. He backed off.

    I am getting way too old for this nonsense, and I no longer care what any MD thinks of my response. I will never back down anymore if put in a situation again.

  8. #8 by torontoemerg on Friday 13 May 2011 - 0951

    Thanks all for the responses. One of the takeaways, I gather, is that experience and confidence count for a lot when dealing with bullies of all stripes. Which is fine, but the problem I have is what about the new grads and the less experienced? Is it reasonable to expect them to be subject to the same harassment until thw get the experience and confidence?

  9. #9 by Dr Dean on Saturday 14 May 2011 - 1900

    Sorry so late in commenting. Thoughtful response to an emotional issue.

    The culture of physician training leads to this behavior in Docs. Until physicians, with administration back-up, deal with the issue, I don’t know when it will stop.

    We have had a small amount of success with the problem at our hospital, but only a small amount.

    It doesn’t bother me if the guy was outed, as long as the behavior described was all true. Sometimes the truth hurts.

  10. #10 by Chris Langston on Friday 20 May 2011 - 0039

    Thanks for this commentary on Ms. Brown’s op-ed. I agree very much with your analysis. In fact I thought that Ms. Brown’s examples of physician bullying were fairly unpersuasive. It was only when I read Drs. Vox and Pho’s responses that I was persuaded I was seeing bullying.

    In fact, worse than their bullying of Ms. Brown, I believe is their claim that somehow talking about a co-worker is somehow unethical. I don’t know what ethical code or system might be involved. Rather it seems like an effort to silence someone through the claim that it violates some health professionals’ code. As far as I know, the only health professionals code is to protect patients, not other professionals. In fact, I believe that health professionals have a positive duty to report behavior that they believe is inappropriate. That they sometimes may be wrong does not relieve them of the obligation when they believe they are seeing inappropriate behavior.

  11. #11 by riskczar on Friday 20 May 2011 - 1026

    I can assure you this is not a health services-specific issue. Bullying is everywhere. I recently wrote about my experience in the financial sector if you’re interested http://riskczar.com/2011/03/18/you-dont-deserve-to-work-for-an-asshole/

  1. Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention « Nursetopia

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