I recently recounted for someone the story of how, during the oral exam for my surgery rotation in medical school, one of the senior attending physicians made me cry. Literally. He belittled and humiliated me, and what was worse, he seemed to be enjoying himself. Now, I don’t think there are very many true sadists in the healthcare profession, but we have to admit that, in the grip of the intensity of what we do, we sometimes lack a certain amount of sensitivity and civility. We are not always respectful.
Sometimes it’s directed toward patients. Not necessarily as overt rudeness, but more subtly, such as keeping people waiting without apology, not introducing ourselves or addressing people by name, etc. Other times it’s a lack of respect for our colleagues. A recent study from the Journal of General Internal Medicine revealed the extent to which physicians criticize other physicians to patients, often with inappropriate language (e.g., “This guy’s an idiot!”). The situation is no better when it comes to relationships among other members of the healthcare team. While perhaps 5% of physicians can be described as chronically disruptive, disruptive behaviors are well documented among both physicians and nurses.
I confess to being guilty myself. As time goes on, I find it harder to get back on task when I am interrupted. It shouldn’t be a surprise that interruptions are very common in the emergency department. But I find that when a nurse “interrupts” something I am doing because there is something that she interprets as more urgent, I sometimes – especially if my perception of the urgency is different – react in a manner that is curt or dismissive. It makes me come across as difficult to approach, which has a negative impact on our ability to work as a team, and ultimately perhaps on the effectiveness and safety of our care. (And needless to say, I am not always correct in that relative perception of urgency.)
Even little things, things we may not ourselves perceive as disrespectful, can damage the team relationship. For example, in a recent survey, only 4% of physicians agreed with the statement that nurse practitioners should be paid the same as physicians when providing the same services. Now, this is certainly a complex issue, but consider what it sounds like to a nurse practitioner to hear that she or he should be paid less for doing the same thing.
Fortunately, a little respect goes a long way. When wait times in the ED are long, trying everyone’s patience, I’ve seen the simple act of apologizing and recognizing the inconvenience to the family melt the icy stare that greeted me when I walked in the room. Thanking a nurse for alerting us to a monitor alarm, telling a physician assistant “nice job” when she picks up an exam finding we missed, talking candidly but with respect to a consultant with whom we may disagree on a management plan – these are all ways of living our value of integrity.