Diverging a little bit from clinical medical education, I want to talk about a consistent, pervasive problem in the world of medicine that isn’t addressed enough – rude, condescending clinicians ( not just physicians ) – who become ‘unapproachable’ owing to their disruptive behavior & temperament. This has become especially relevant in the post-pandemic era of ‘Antiwork’ & ‘Quiet-quitting’ amidst worker shortage we are seeing across most industries – especially healthcare – where quitting is the norm if work unecessarily elevates stress levels. Bullying is seen across all industries, but in healthcare they can cost patient lives.
Such clinicians can directly endanger patient safety and can be argued as being a medical error – For example, a new nurse may not realize that a new clinical finding is critical and may neglect to report to a rude physician since they are terrified of being scolded for ‘bothering’ the doc. Trainee residents may make more errors being nervous around a rude attending. Interestingly a Randomized Controlled Trial (RCT) was published in 2019 to show exactly this – Anesthesiology trainee residents were randomly assigned to rude and normal environments, performance was signigicantly worse in the rude-environment group. Even professional medical teams are affected. A RCT published in 2015 had various groups of medical NICU teams with a doc and nurses treat a patient in a simulated clinical scenario. Groups randomly exposed to ‘mildly rude comments’ from observing experts did significantly worse than the others !
‘Toxic’ clinicians also cost the organization money if staff decide to quit because of them. As this article notes – “The disruptive physician or professional undermines practice morale, heightens turnover in the organization, steals from productive activities, increases the risks for ineffective or substandard practice, and causes distress among colleagues.“.
This 2022 publication discusses a protocol to study such rude behaviors in the UK national health service and then propose ways to reduce it – that will be interesting ! My take is when litigation & monetary accountability of such toxic behaviors become mainstream, that’s when we will see more rapid changes – money speaks loud ! Rude behavior by itself cannot be sued, like this case shows, but proving it directly resulted in medical harm could be ! Hospitals are also important stakeholders since staff turnover is expensive. First step in this direction is formal reports on such behaviors, and this is already happening as hospitals are beginning to subscribe to reporting systems – A popular one is the PARS ( Patient Advocacy Reporting System ) and CORS (Coworker Observation Reporting System) maintained by Vanderbilt University’s Center for Patient and Professional Advocacy. A physician gets a ‘risk’ score based on unsolicited patient complaints and coworker observations. This is something you could advocate your hospital to be a part of to help with creating a change for the better.
If only being rude was actually fun , like at the Weiner’s circle in Chicago !
