May 10, 2011 | | Comments 0
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Commanding respect from disrespectful physicians

by Wendy Leebov, Ed.D.

“I work days and try to have everything ready when the doctors come in (labs in charts, vitals done, etc.). But they are immediately demanding everything at once, not giving me a minute to collect my thoughts and focus on the patient in question. Then, they treat me like I’m stupid when I don’t give the answers almost before they ask the question!”

Alan Rosenstein did a revealing study about nurse-physician relationships.

A few findings that struck me:

  • More than 92% of nurses had witnessed disrespectful and/or disruptive behavior by physicians.  The most common behaviors cited include yelling, raising the voice, condescension, berating colleagues, berating patients, and use of abusive language.
  • Common generalizations about abusive behavior on the part of physicians make it seem as if most physicians are “abusive.”   However, in Rosenstein’s study, nurses clarify that very few physicians are abusive. The vast majority are not. I think that’s VERY important to remember.

Still, the instances of abuse stick in the craw of not only the people on the receiving end, but also on people who witness it.  So, it’s important to address this behavior, so that it doesn’t erode morale, teamwork and patient outcomes. Of course, that’s not so easy, because many caregivers feel intimidated about speaking up to stop respectful or abusive behavior because of fear of retaliation, lack of assertiveness, and/or a sense of hopelessness that the person’s behavior will ever change.

What to Do?

There’s a lot an organization can do, and should do, such as:

  • Commit to and make explicit a code of conduct and link it to your vision, values and standards. Highlight the impact of teamwork, collaboration and communication on quality, patient satisfaction, risk reduction, safety, and outcomes.
  • Zero tolerance. Institute and enforce a zero tolerance policy about coworker disrespect.
  • Adopt a “respect” signal. Decide on something anyone can say when they witness inappropriate behavior—a signal that means “You have crossed the line.”  Stopped in their tracks, many people become more aware of their behavior and more accountable for it.  My favorite signals:

o     “Time out.”

o     “How about a cup of coffee?”

  • Physician-nurse rounding.  Have physicians and nurses round on patients together and provide training to support effective communication during these rounds.
  • Provide personal coaches for individuals who behave in an outrageous way.
  • Adopt-a-Doc: Have nurses each adopt a physician with whom they will deliberately build a positive relationship and for whom they will act as an advocate.
  • Provide assertiveness training for nurses! This is critical!
  • Discussion forums: Provide forums in which physicians and nurses talk to each other!

BUT, while the organization can work to reduce abusive or disrespectful behavior between nurses and physicians and among colleagues in general, in my view it is essential that the individual who perceives the behavior takes responsibility to address and handle it effectively, one situation and one person at a time.

What can the individual do?

In one of my roles years ago, I was in a position to field physician frustrations every day.  My friends called me the LIVER of the organization, because so many toxins flowed through me.  In my early years, in the face of a hostile physician, I would get defensive or cower.  Both approaches seemed to increase the behavior I was hoping to eliminate.  Then, after spending about $5 million on therapy, I learned other MUCH more effective techniques, and I have had a less stressful life ever since, because these techniques WORK.

Tips from my experience:

  • Alter your own inner monologue. These are the statements you say to yourself.  Look within:  What do you say to yourself when someone is abusive to you?  “This jerk!  How awful!  Poor me!  I hate this!  I don’t deserve this!”  If your inner talk makes you angrier or more defensive, change it.  You CAN decide to think something different, such as, “This is not about me,”  “I deserve respect,” “I don’t have to react,”  “I can stay calm and help this person,”  “I can take the high road here.”
  • Don’t respond in kind. It’s human nature to want to strike back when attacked.  Resist.  Handle the inappropriate behavior respectfully.  Stay on the high road, since this will make you most effective and also enable you to feel good about yourself at the end of the day.  CALMLY SAY, “What is happening is not okay.”
  • Give direct feedback without anger.  “I saw you do this….” or, “I don’t appreciate your tone,”  “I would appreciate your keeping your voice down,”  “When you belittle me in front of our patients, I resent it and it makes it hard for me to support you.”
  • When someone is verbally attacking, instead of getting defensive, make explicit your positive intent. Instead of saying, “WHOA!  Hold it a minute” say, “You know, I really want to help you.”  Then if they persist, say that over and over in a sincere tone, “As I said, I really DO want to help you.” And then wait until they have vented enough to allow them to calm down and address the facts of the situation with you.
  • Use the caring broken record.  In the face of persistent disrespect, repeat your bottom line message each time with caring.  “I hear how frustrated you are, and I really want to support you,”  “I realize you’re under extreme pressure, and I really do want to provide the support you need,”  “I’m sorry this isn’t what you wanted.  I really do want to help.”
  • If the abuse continues, remove yourself from the situation. “I’m hanging up now.  Please call me back when you’re ready to talk with me in a respectful way about this.  I really do want to help you.”
  • “There you go again.” If you’ve addressed the behavior over and over and it still hasn’t changed, when it happens next, say very calmly, “There you go again.  I want to discuss this with you when we can both be respectful.”  And do that EVERY time it happens again.

And with your TEAM:

Talk about the elephant in the room. Work together with your team to identify great ways to respond to the disrespectful or inappropriate behavior you handle most often.  I’ve provided a worksheet to guide your discussions.  You can be sure you’re not alone.  So, the activity will help everybody.

Healthcare environments are inherently stressful and it’s upsetting to think about the times when colleagues add to this stress instead of relieving it.  To be effective and to do your part in altering an atmosphere of disrespect, it takes courage and caring — backbone and heart.

For helpful resources about handling disrespectful behavior, click here.

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Wendy Leebov About the Author: Wendy Leebov is a passionate advocate for creating healing environments for patients, families and the entire healthcare team. A mission-driven expert, Leebov provides outcomes-based consulting services, culture change strategies with healthcare organizations, training and tools for enhancing the patient and employee experience. With more than 30 years of experience and skills in communication, training design and delivery, she is known for making hard skills accessible and motivating people to stretch and apply skills which set them apart. Author of 12 books for healthcare, Wendy has produced two groundbreaking video-based skill building systems that educate and empower all staff to deliver the exceptional patient experience consistently by excelling at caring communication. Wendy writes a free monthly e-newsletter - HeartBeat on the Quality Patient Experience - packed with concrete tips and tools for managers who champion the great patient and employee experience. Visit Wendy’s website for more great tips and tools.

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