Managing Physician Incivility - 101
- Connie Montalbo
- Jun 21, 2019
- 4 min read
Updated: Jun 21, 2019
I have worked with incredible, kind, fantastic physicians. Some are even close friends of mine. Unfortunately, what the research reflects, and what I have personally witnessed, not all doctors know how to play nicely in the sandbox. As nurses, not only do we have to live with disruptive behaviors from our own, we also live with physician disruptive behavior, but the impact is quite different. Physicians have a level of implied power that surpasses that of anyone else in healthcare, so when they are disruptive, the emotions, implications, and impact on the team are at an exponential level.
As a clinician, I witnessed a physician remove a placenta from a uterus and throw it against an OR wall, splat! My first thought was, “WHY?” as in “why would any adult think this is acceptable on any level?” But that was only one of many physician outbursts displayed during my time as a bedside nurse. I witnessed physicians multiple times yelling at my peers with some exhibiting full-on temper tantrums. Once, on a very busy night shift, when I called the OB and said to come immediately due to an emergent situation with his patient, …after a long silence, he hung up on me. Zero response, and a dead phone! I called our house administrator who did reach him (while we were still in the middle of the emergency, I was calling our administrator to deal with him rather than be at my patient’s bedside). He arrived a short time later only to scream at me for “reporting” him. Zero insight into the wrongness of his behavior!
As a leader, I have dealt with countless disruptive physician behaviors. “Yes, nursing must call you for critical values. No, they are not stupid, it is a patient safety issue and a policy to ensure we do not miss providing care.” “It is her job to place a query on your chart! No, I do not agree that the query means she does not care about patients.” “No, he will not lie to your patient and say that he gave 2mg of Dilaudid when you only ordered 1mg.” “No, she is not incompetent because when you held out your hand and did not ask for the specific instrument you wanted, she placed the wrong one in your hand.” All real-life conversations, all in recent years.
One of my favorite “is this for real situations” … I was new at the organization. I was called to the CEO’s office. I was told that my entire night shift in the ICU had called in. I asked why. As matter-of-fact as possible, the CEO told me that our intensivist had gone on yet another rant, and now the nurses were refusing to come in if he was there. Being new, I asked the obvious… if this was an ongoing issue, why had his behavior not been addressed? I was told, “don’t worry about him, just get your nurses to work!” This from a CEO who prided himself on the organization’s culture!
The list goes on. Disruptive physician behavior is an issue. I wonder if there is an urban med-school myth that makes physicians believe that in nursing school we teach a class called, “Tolerating Rude Physicians 101 ?” As leaders, not only must we have zero-tolerance for incivility from our employees, we must also have zero-tolerance for incivility from our physicians. We cannot let the fear of a physician moving her practice down the street keep us from holding her accountable to our values. What does it say to our employees when we as leaders look the other way? Not to mention, the overwhelming evidence that supports that physician disruptive behavior leads to patient harm.
Some noted behaviors that must be addressed include: Physicians who do not return calls; physicians who are disrespectful about the nursing team when talking with a patient; physicians who hang up or yell at the nursing team; physicians who threaten to get our nursing team fired; physicians who “fire” nurses from caring for their patients; physicians who refuse to respond to requests to come and assess their patients; …to name just a few.
If we do not tolerate disruptive behaviors from our employees, we should not tolerate disruptive behaviors from our physicians!!
Managing disruptive physician behavior is not much different than managing disruptive employee behavior. It is our obligation as leaders to communicate with our physician team, to ensure they are held accountable to our behavioral standards, and to have zero-tolerance for behaviors that do not align. Some organizations do a better job than others and some have truly made great effort to address disruptive behaviors from the medical team. Some organizations still struggle with this basic leadership obligation.
Quick Suggestions for What Your Team Can Do When Faced with Incivility:
As for helping your team manage disruptive physician behaviors “in the moment”, these are some tactics I have encouraged my team to use when faced with unexpected incivility…
Ask the person who is yelling or being disruptive to lower her voice. An option is to say, “I can hear you even if you are not yelling.” I make sure my teams know that they are not expected to tolerate verbal abuse from anyone including physicians.
If the uncivil behavior is on the phone, I encourage my nurses to ask the person to stop yelling, and if the yelling doesn’t stop, to say, “I am hanging up but will be glad to talk with you when you stop yelling at me.” (Just a caveat to this approach, once the phone is hung up, your employee should call you as you will probably be hearing from your administrator on call).
I have told my team to offer my number to any physician yelling at them as I would be happy to be the diffuser.
One of my favorite suggestions for my team…once a behavior is becoming disruptive on the unit, rather than confront the physician or try to defend oneself, the rest of the team needs to walk to the victim (and yes, when you are being screamed at, you are a victim), join hands, or stand shoulder to shoulder, in a show of solidarity for the victim. No communication, flat affect, just silent support for your colleague.
Whether it is our staff or our medical team, our employees deserve for us as leaders to enforce a zero-tolerance approach. Ending incivility from every direction is not only what employees should expect from their leadership team, it is what they are entitled to!
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