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Nurse, Medics, RTs, etc., Heel Thyself

Charles Brault c_brault at yahoo.com
Sun May 15 10:57:20 BST 2011

I don't know,
To me
This very example in this article
Is way more telling 
- Of the nurses (Medic, RTs, etc.) persisting inferiority complexe/Insecurity 
and an indice of their new and evolving affirmation of (professional) 
self-assurance (a good thing)
- The MDs arrogance and old & persistent attitudes

May 7, 2011
Physician, Heel Thyself
IT was morning rounds in the hospital and the entire medical team stood in the 
patient’s room. A test result was late, and the patient, a friendly, middle-aged 
man, jokingly asked his doctor whom he should yell at. 

Turning and pointing at the patient’s nurse, the doctor replied, “If you want to 
scream at anyone, scream at her.” 

This vignette is not a scene from the medical drama “House,” nor did it take 
place 30 years ago, when nurses were considered subservient to doctors. Rather, 
it happened just a few months ago, at my hospital, to me. 

As we walked out of the patient’s room I asked the doctor if I could quote him 
in an article. “Sure,” he answered. “It’s a time-honored tradition — blame the 
nurse whenever anything goes wrong.” 

I felt stunned and insulted. But my own feelings are one thing; more important 
is the problem such attitudes pose to patient health. They reinforce the 
stereotype of nurses as little more than candy stripers, creating a hostile and 
even dangerous environment in a setting where close cooperation can make the 
difference between life and death. And while many hospitals have anti-bullying 
policies on the books, too few see it as a serious issue. 

Today nurses are highly trained professionals, and in the best situations we 
form a team with the hospital’s doctors. If doctors are generals, nurses are a 
combination of infantry and aides-de-camp. 

After all, patients are admitted to hospitals because they need round-the-clock 
nursing care. We administer medications, prep patients for tests, interpret 
medical jargon for family members and double-check treatment decisions with the 
patient’s primary team. Nurses are also the hospital’s front line: we sound the 
alert if a patient takes a serious turn for the worse. 

But while most doctors clearly respect their colleagues on the nursing staff, 
every nurse knows at least one, if not many, who don’t. 

Indeed, every nurse has a story like mine, and most of us have several. A nurse 
I know, attempting to clarify an order, was told, “When you have ‘M.D.’ after 
your name, then you can talk to me.” A doctor dismissed another’s complaint by 
simply saying, “I’m important.” 

When a doctor thoughtlessly dresses down a nurse in front of patients or their 
families, it’s not just a personal affront, it’s an incredible distraction, 
taking our minds away from our patients, focusing them instead on how powerless 
we are. 

That said, the most damaging bullying is not flagrant and does not fit the 
stereotype of a surgeon having a tantrum in the operating room. It is passive, 
like not answering pages or phone calls, and tends toward the subtle: 
condescension rather than outright abuse, and aggressive or sarcastic remarks 
rather than straightforward insults. 

And because doctors are at the top of the food chain, the bad behavior of even a 
few of them can set a corrosive tone for the whole organization. Nurses in turn 
bully other nurses, attending physicians bully doctors-in-training, and 
experienced nurses sometimes bully the newest doctors. 

Such an uncomfortable workplace can have a chilling effect on communication 
among staff. A 2004 survey by the Institute for Safe Medication Practices found 
that workplace bullying posed a critical problem for patient safety: rather than 
bring their questions about medication orders to a difficult doctor, almost half 
the health care personnel surveyed said they would rather keep silent. 
Furthermore, 7 percent of the respondents said that in the past year they had 
been involved in a medication error in which intimidation was at least partly 

The result, not surprisingly, is a rise in avoidable medical errors, the cause 
of perhaps 200,000 deaths a year. 

Concerned about the role of bullying in medical errors, the Joint Commission, 
the primary accrediting body for American health care organizations, has warned 
of a distressing decline in trust among hospital employees and, with it, a 
decline in the quality of medical outcomes. 

What can be done to counter hospital bullying? For one thing, hospitals should 
adopt standards of professional behavior and apply them uniformly, from the 
housekeepers to nurses to the president of the hospital. And nurses and other 
employees need to know they can report incidents confidentially. 

Offending parties, whether doctors or nurses, would be required to undergo 
civility training, and particularly intransigent doctors might even have their 
hospital privileges — that is, their right to admit patients — revoked. 

But to be truly effective, such change can’t be simply imposed bureaucratically. 
It has to start at the top. Because hospitals tend to be extremely hierarchical, 
even well-meaning doctors tend to respond much better to suggestions and 
criticisms from people they consider their equals or superiors. I’ve noticed 
that doctors otherwise prone to bullying will tend to become models of civility 
when other doctors are around. 

In other words, alongside uniform, well-enforced rules, doctors themselves need 
to set a new tone in the hospital corridors, policing their colleagues and 
letting new doctors know what kind of behavior is expected of them. 

This shouldn’t be hard: most doctors are kind, well-intentioned professionals, 
and I rarely have a problem talking openly with them. But unless we can change 
the overall tone of the workplace, doctors like the one who insulted me in front 
of my patient will continue to act with impunity. 

I wish I could say otherwise, but after being publicly slapped down, I will 
think twice before speaking up around him again. Whether that was his intention, 
or whether he was just being thoughtlessly callous, it’s definitely not in my 
patients’ best interest. 

Theresa Brown, an oncology nurse, is a contributor to The Times’s Well blog and 
the author of “Critical Care: A New Nurse Faces Death, Life and Everything in 


May 14, 2011
When Doctors Humiliate Nurses
To the Editor: 
Re “Physician, Heel Thyself” (Op-Ed, May 8): 
As a nurse for more than 25 years and the author of a book to teach nurses how 
to combat bullying from physicians and others in health care, I applaud Theresa 
Brown’s first-person account of her experience. 

Beyond humiliating nurses, physicians who abuse nurses endanger the very 
patients they profess to protect. Leadership from health care administrators, 
medical staff and policy makers is needed to change this appalling practice. 
What other profession would tolerate such abuse? 

Nurses, too, can rally around an abused nurse in a practice called “code pink.” 
The word is passed nurse to nurse, and colleagues gather around the beleaguered 
nurse. Few physicians can stand the scrutiny of neutral-faced nurses standing 
silent beside one of their own. 

At more than three million strong, nurses are the largest group of health care 
professionals. They, and their patients, deserve better. 

St. Louis, May 8, 2011 
The writer is the author of the forthcoming book “Becoming Influential: A Guide 
for Nurses” (second edition). 

To the Editor: 
There are some medical issues I wish we could end once and for all. As Theresa 
Brown wrote, doctor superiority, especially at the expense of nurses and other 
staff, is one of them. 

The best doctors I know consider themselves part of a team and use the team’s 
knowledge to the advantage of the patient. They think “patient first” and draw 
on the experience of nurses, laboratory technicians and other medical 
professionals. The patient receives the doctor’s best treatment advice based on 
the collective knowledge of the team. 

Doctors who accept only their own counsel are putting ego before medicine, 
possibly at the expense of the patient. Hospital care should be based on 
collective wisdom to reach the best treatment plan. Nurses, doctors and all 
highly trained medical professionals each have a role to play, each of which is 
invaluable to the patient. 

President and Chief Executive
NewYork-Presbyterian Hospital
New York, May 9, 2011 
To the Editor: 
Today, hospitals pride themselves on providing patient-centered care by a 
multidisciplinary team, a hallmark of their quality. When one team member 
bullies another, patient care suffers. As a nurse, I would not want my family 
member or my nursing students in a hospital where physicians demean and insult 
their nurse colleagues, thus hampering their ability to care. 

A culture of civility and a climate of respect and dignity not only win the day 
but also ensure patient safety and quality care. 

It’s time physicians learned that nurses are on their team, poised to manage 
complex critical decisions and care for their patients. Please, no bullying — it 

Old Greenwich, Conn., May 8, 2011 
The writer is a nursing professor at Hunter College, Hunter-Bellevue School of 

To the Editor: 
I cry out from the absolute bottom of the health care totem pole, a desperate 
plea from a lowly third-year medical student. The unprofessional behavior cited 
by Theresa Brown is sent on down the line from the top doctors to the house 
staff to the nurses and eventually to students like me. 

Ms. Brown is right: institutionalized standards of professional behavior and a 
way to submit confidential incident reports should be in place, but is it really 
too much to ask health care professionals just to take a stance and pledge to 
treat one another right, regardless of this arbitrary hierarchy we’ve created? 

In the meantime, I’ll pass along some advice I got from my seventh-grade 
guidance counselor about bullying: “Annie, just kill ’em with kindness.” 

New York, May 8, 2011 
To the Editor: 
Of course nurses aren’t the only target of doctor-bullying. Patients, too, 
cannot guarantee that their doctors will treat them as equals. And sometimes 
they can be patronized in front of strangers. 

During my stint as a linguistic researcher at a rather famous Northeastern 
hospital, I attended daily rounds for new doctors. One (memorable) morning, the 
attending physician was proudly displaying to his audience all the skills that 
had been lost by an elderly man who had recently suffered a stroke. Look at how 
he cannot repeat after me, how he has trouble holding up two fingers, now three 
fingers and so on. 

The doctor then filled a small cup with water and asked the patient to slowly 
raise it and drink from it, all the time winking at us that he wouldn’t be able 
to do so. The cup got halfway to the patient’s mouth, at which point revenge was 
had: he tossed the water all over the physician. 

Brooklyn, May 8, 2011 


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