Physician, Heel Thyself

In a New York Times opinion piece, Theresa Brown wrote about doctors showing disrespect for nurses.

Ms. Brown acknowledges that most of her interactions as a nurse with physicians are civil and professional but that the exceptions are notable. One reason that they are notable is the emotional impact of incivility. Rude behavior excludes its target from the community of people deserving of respect. It most directly devalues the other person.

The article also acknowledges the widespread incivility shown by senior nurses to their protégées. Rather than mentoring, these interactions seem designed to put the newbies in their place and that place is somewhat demeaning. She argues that these interactions reflect a culture of disrespect fostered by the actions of high status members of the health care community.

A recurrent theme through this article and other writings on workplace incivility is that people have a capacity to use any visible distinction as a basis for showing disrespect. Individuals who belong to groups with more privilege have a tendency to disparage others who lack those privileges. People are inclined to compare themselves to others. Problems emerge when use differences derived from their professional responsibilities as indicating differences in their value as people.

A relevant perspective comes from the CBC radio show, White Coat, Black Art, in which the show’s host, a physician, argued that nurses were over-credentialed. This opinion seemed built upon view of nursing as keeping the patient tidy until the doctor came along to do the treatment that really mattered. This perspective communicated either a lack of awareness of nurses’ actual practice in current hospital environments or a lack of respect for that work.

Again, most physicians understand and respect the challenges and complexity of other health care professionals. And most physicians are conscientious in showing respect to their colleagues and to people in general. But some fail to do so consistently.

With their elevated status in hospitals and in society generally, physicians can have a disproportionate impact on others. What they may experience as a small slip or a justified, momentary expression of frustration can have a lasting impact on another professional’s career.

Programs that actively promote civility among health care professionals foster a culture of respect that both reduces the prevalence of incivility and helps people recover from expressions of disrespect when they occur.

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