Hospital bullies pose a danger to patient safety

Tools

Disrespectful doctors create a "bullying culture" in hospitals, which organizations must address to improve patient care, argues a column in Aeon Magazine.

Mistreatment of subordinates, particularly medical students, is widespread, argues Ilana Yurkiewicz, citing one national study that found a majority of students report they were bullied in some way. Although her own experience was, for the most part, free of such mistreatment, Yurkiewicz writes, she has witnessed bullying behavior in hospitals.  

"The surgeon who chides the nurse for her inability to be in two places at once? The nurse who snaps at the medical student for reading the patient's chart the same moment she wants to write it in?" she writes. "They are a substantial, troubling minority, and they can set the mood for the rest."

The most common form of hospital-based bullying is not the loud outburst, Yurkiewicz says, but rather what sociologists call "microaggressions," subtle interactions that shame employees and undermine their confidence. Microaggressions could take the form of calling employees by rank rather than name, publicly shaming them for incorrect answers or even something as small as a sarcastic tone. "These are the acts that affect our state of mind in small but cumulative ways," she writes. "This is the stuff that creates a culture."

This isn't just psychologically damaging to staff, according to Yurkiewicz; it also affects patient outcomes. For example, an abusive attending physician may discourage residents and nurses from openly discussing a patient's problems, which gives time for those problems to worsen. "In a system dependent on hierarchy, it works like this: when anger and intimidation flow down, information stops flowing up."

The culture continues to thrive, she writes, because of a perception that harshness whips employees into shape. "Arguments such as these run counter to all the data we have on patient outcomes. Brutality doesn't make better doctors; it just makes crankier doctors. And shame doesn't foster improvement; it fosters more mistakes and more near-misses."

This correlation echoes results from a 2013 study in the UK, which found that one in four doctors and surgeons and one in three nurses said bullying has caused them to behave in ways that are bad for patient outcomes, FierceHealthcare previously reported.

To learn more:
- read the column

Related Articles:
Docs, nurses bullied into poor care
Even amid strong opinions, docs must keep online conversations civil
Survey: Doc verbal abuse is contagious
Interprofessional education: The answer to better healthcare communication