How To Deal With Disruptive, Rude Physicians

When I was a new nurse, I was scared of Dr. Rothschild. He had the arrogance of Steve Jobs and since I was a brand new, shy, and insecure nurse, he intimidated the heck out of me. I prayed everyday that I wouldn’t be assigned one of his patients. He was notoriously known for being rude, condescending, and intimidating towards nurses and his interns. For months, I avoided him. However, one day, I was called into my patient’s room. Thinking it was the patient who needed something, I casually strolled into room 12. Dr. Rothschild was standing there with his interns waiting for me. He was the one who summoned me. In a sharp tone, he asked me why HIS patient was still in bed. I immediately felt a surge of hydrochloric acid well up in my stomach and lost my peripheral vision for a moment. I seriously didn’t think I could produce sound but what came out sealed my death. I replied, “He is on bed rest.” Immediately Dr. Rothschild told me to wait there, left the room, but then stormed back in a few minutes later carrying the patient’s chart. He opened it and with his pen underlined HIS order, “Get patient OOB (out of bed),” which was written earlier that morning. After the incident, I had a visceral reaction and spent the next 15 minutes in the bathroom.

My encounter with Dr. Rothschild affected me for a long, long time. But think about the impact his behavior had on my ability to care for the rest of my patients – the rest of my shift. Was I able to think, manage information, and make good decisions after that? Was I able to critically think, problem solve or communicate effectively? Heck no. I just kept replaying that scene over and over again in my brain. His rudeness affected my performance.

Rinse and repeat this situation over and over again in our current healthcare environments. Make no mistake about it. Rudeness is impacting patients and your ability to cultivate a healthy workforce.

According to Amir Erez’s study on rudeness on medical teams, a rude comment by a physician decreases the performance among other doctors and nurses by more than 50%. What he found was that rudeness “damages your ability to think, manage information, and make decisions.”

The study also suggests that rudeness may contribute to many of the preventable deaths caused by medical error in US hospitals.

But how?

Mild incivility and rudeness towards a member of the healthcare team can have profound, if not devastating, effects on patient care. Because, rudeness interferes with working memory.

Physicians who treat nurses with disrespect endanger the very patients they profess to protect. Yet, we frequently ignore, justify, or rationalize rude physicians by saying things like…

"Just ignore her like everyone else does”

“He is beastly on a good day.”

“She’s a great physician but don’t get on her bad side.”

“He’s untouchable because he brings a ton of money to the organization.”

Sometimes, we go so far as to warn new nurses about certain physicians. I remember when I was a new neuro nurse and my coworkers warned me about a certain neurosurgeon who rounded early in the morning. This surgeon would “rip you a new one” if he arrived on the unit and his patient wasn’t sitting in a chair – at 6am. Trust me. I experienced his wrath once. That was enough for me!

When I complained to my boss, she blew me off and said, “Don’t take it personally. Just ignore him. He’s a really great surgeon.”

We need to do better

Studies show that safer patient care and healthier work environments occur when the healthcare team is trained and empowered in teamwork skills. It’s about the team – not a person or a role.

So, what can we do?

If you’re a nurse

I admit that sometimes physicians intimidate me too, especially if they aren’t overtly warm and fuzzy. However, I’ve learned to articulate my value as a professional nurse by communicating in a way that reinforces collaborative practice with all members of the healthcare team. We each bring something unique to the team.

I spoke with a manager recently about a situation where a physician was very rude and condescending towards her new nurse. The new nurse complained to this manager who then talked to the physician. She asked the physician to apologize to her nurse. He did but then the new nurse said this, “It’s okay. Don’t worry about it.” NOOOOOOOOOO!!

• If you’re a nurse and a physician apologizes to you, say this, “Thank you for apologizing to me.” When you say this, it reinforces that it’s unacceptable for anyone on the team to communicate in a disrespectful manner. It doesn’t matter who the person is or what the person does.
• If a physician is yelling, criticizing, or being very condescending to you, especially in front of others, say this: “It’s not okay the way you’re speaking to me right now.”
• If you witness a physician being rude, condescending, or is overtly criticizing a coworker, interrupt and say, “Excuse me. The way you’re communicating with him (her) is not okay.”

Speak up and set the intention that you and everyone on the healthcare team expect to be treated with respect.

If you’re a physician

To counter the hierarchical power struggle that exists in healthcare, go out of your way to level the playing field. You do this by finding opportunities to make everyone on the healthcare team feel as though they matter, that their opinion counts, and that they are equally valuable to the delivery of patient care.

• When a nurse calls you at 2 o’clock in the morning and starts the conversation with, “I’m sorry to bother you…” Say this, “Please don’t apologize. If this was my mother, I’d want you to call me…”
• Knowing that nurses might be fearful to let you know they think you’re making a mistake, say this…” “I’m the primary physician responsible for this patient…please tell me if you find me making a mistake."
• When rounding on patients, introduce yourself to everyone on the team. Shake hands and ask for names. When rounds are over, thank everyone for their input.

Imagine if Dr. Rothschild would have approached the situation with genuine respect and intent to help me deliver the best possible care to his patient. He could have introduced himself to me and asked for my name. He could have asked if I saw his order yet and that he really wanted his patient to get out of bed early. He could have explained his reason. He could have…he could have…he could have…but he didn’t.

Cultivating a respectful, professional, and collaborative workforce culture is possible when we all stop tolerating disrespectful, rude, and disruptive behaviors from EVERYONE on the team. Even physicians.

I’d love to read your comments about this topic and perhaps any success stories you’ve had when addressing rude, disrespectful physicians.

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