Victoria Bradley (King’s College Hospital NHS Foundation Trust, London, UK) and others report in Clinical Medicine that cardiology is among the departments/specialists seen as most likely to engage in rude, dismissive and aggressive behaviour towards colleagues. They add that being busy and overworked is a key reason why doctors are rude to their colleagues.
The authors claim that “relatively little work” has been done on how frequently doctors engage in rude, aggressive dismissive behaviour to colleagues or what impact such behaviour has, commenting that “workplace incivility” is distinct from bullying “which is a more persistent and power-based form of abuse, most commonly occurring within a department”. Therefore they used a survey to identify the frequency of rude behaviour, who perpetrates rude behaviour, and the impact of such behaviour and focus groups to discover experiences of rudeness, what triggers rude behaviour, and (again) the impact of such behaviour.
Of 606 the doctors who responded to the survey (which was sent to all employed doctors at three UK teaching hospitals), overall, 31% said that they were “personally subject” to rude behaviour multiple times per week. However, junior doctors and registrars (43% and 38%, respectively) were more than twice as likely to experience rude behaviour as consultants (18%). The rude behaviour experienced, as revealed in the focus groups, ranged from someone being sworn at by a more senior colleague after they called them in the early hours of the morning for advice to people having their views ignored because they were female or a certain ethnicity.
Forty per cent of respondents claimed—Bradley et al report—that rude behaviour “moderately or severely affected their working day” with 7% saying that rude behaviour caused them to make a mistake at work. The authors add based on the results of their study, the only time when rudeness was seen as acceptable was when patient safety or dignity had been “acutely threatened”, citing a respondent who admitted being rude to colleague because they had not “set up a patient’s fluids” and the said patient “could have died” without them.
The authors note that survey respondents “repeatedly and consistently” named radiology (27%), general surgeons and surgical specialists (20%), neurosurgeons (18%), and cardiology (17%) as the departments or types of staff who were most likely to be rude to colleagues. Bradley et al comment that there was “widespread recognition” that doctors who are busy or overworked were more likely to be rude, but add “differences in departmental cultural” may also play a role in why some departments are ruder than others because “not all specialties that are acute and high intensity are reported to exhibit rudeness”.
Bradley et al say that rude, dismissive, aggressive behaviour is “not an effective or reasonable coping strategy in response to overwork”, adding “venting of anger has been shown to fuel aggression rather than dissipate it and the expression of rudeness is likely to be counterproductive”. They conclude: “Changing this behaviour is likely to be challenging. The recognition that rude, dismissive, aggressive behaviour is damaging and counterproductive is an essential initial message that needs dissemination.”
Study investigator Benjamin C Whitelaw (King’s College Hospital NHS Foundation Trust, London, UK) told Cardiovascular News: “This work arose from the Francis report, which raised the question whether some aspects of hospital culture can be damaging to safe clinical practice. The work demonstrates that doctors often experience aggressive, rude and dismissive responses to their requests and referrals, especially from high intensity specialties. This kind of behaviour causes distress and is also damaging to cooperative working and to patient safety.
“Aside from raising the awareness of this behaviour and reflecting on its acceptability, departments could consider how they use their available resources to handle the pressure of referrals. The use of electronic referral systems, nurse specialists, and protected times for referral work have all been proposed to reduce workload intensity, which may in turn help improve communication.”