Nearly a third of English doctors report that they are subject to rude, dismissive and aggressive (RDA) behavior more than once a week. Cardiologists are among the specialists who are most likely to be responsible for this “workplace incivility.”
These are some of the chief findings of a survey published in Clinical Medicine of 606 British doctors at three teaching hospitals.
The authors of the paper write that they hope to correct “a perception that rudeness is a mild word, for a mild problem; that as it is a part of everyday life and resilience to it should be a normal part of our reactions and behaviour.” Instead, they say, rude behavior “is a widespread problem with a large impact on individuals and healthcare organisations.”
Younger and more junior doctors were more than twice as likely as senior doctors to report rude behavior. 43% of junior doctors and 38% of registrars (specialists in training) reported RDA multiple times a week, compared with only 18% of senior doctors (consultants).
Certain specialties were were more often linked to bad behavior: radiologists were mentioned by 27% of respondents, general surgeons by 20%, neurosurgeons by 18%, and cardiologists by 17%.
It should be noted that the respondents represented only 15% of the physicians who were sent the survey. The authors acknowledge the “potential for selection bias… because doctors affected by negative behaviour may be more motivated to participate.”
Despite the high rate of reported abuse, 86% of the respondents said they they never or only rarely were themselves guilty of this bad behavior.
40% of the surveyed doctors said that RDA behavior “moderately or severely affected their working day.”
In two small focus groups a small number of the respondents described some of the “more insidious examples of rudeness,” including “undermining, unwillingness to help, sexism and racism.”
One respondent said, “I’ve had situations where people…haven’t listened to me because I’m a woman. Other colleagues who’ve not been listened to because their particular ethnicity.”
Based on personal experience the difference in behavior based on status was obvious to one doctor: “…having worked here as a junior and then as a consultant, it always amazed me that the attitude of people underwent a miraculous transformation once you announced that you were consultant…” The authors said that the younger doctors felt the bad behavior often occurred in the setting of “a power imbalance.”
Are Cardiologists Really More Rude?
Does this mean that cardiologists, along with their neurosurgeon, general surgeon, and radiologist partners in crime, are really worse than other doctors? This survey, of course, can’t begin to prove such an assertion, but it does offer some plausible evidence that a fair number of doctors in England think it’s true.
When I tweeted the cardiology-related results of the paper last week I appeared to touch the nerve of at least one cardiologist. He said my tweet was irresponsible, “akin to Trump’s murder statistics regarding blacks.” The study itself was “offensive,” “inaccurate,” “poorly researched,” and “not likely generalizable to US cardiologists.”
Because I’m a firm believer in the principle that anecdote does not equal data I won’t say that this extreme response actually helps confirm the study finding, but it certainly doesn’t offer any evidence against the hypothesis either.
I suppose cardiologists can take some comfort that they weren’t cited as often as radiologists.
This one survey can’t begin to determine whether cardiologists (and the others) really are more rude, and of course it can’t shed light on whether the situation is any different in the US than in the UK. However, at the very least the study strikes me as a good basis for discussion and, for doctors, self-reflection.