On Rudeness

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“Hey Tessa, I didn’t realise you were such a genius”.

I was on my way back to ED from my lunch break and the ortho reg was sitting laughing with one of our locum SHOs.

I smiled nervously, “Oh thanks for coming to see the patient”.

“I didn’t realise you were a genius”. He said it again. He was still smiling. It was weird.

“I’m not sure what you mean, but something about this is making me nervous”. I was trying to make a joke of it. But let’s be honest, I’m not a genius, so I had a sense that something wasn’t right.

“You told my patient that they could eat and drink. They need an operation and now they aren’t fasted. Thanks for that, genius!”

I have since thought of a gazillion things I could have said. Like, “I didn’t tell them they could eat and drink!” or “Hang on, there’s no need to be rude” or “You’re setting a really bad example to this locum SHO about how to be courteous to your fellow colleagues” or “It doesn’t cost to be kind!”.

Actually, he walked away before I could say anything else. I’ve spent the weeks since pondering over it endlessly. That’s pathetic, right?

Yes, we work in busy and stressful environment. We have all snapped from time to time, it doesn’t mean that you’re a bad person, or a terrible doctor. But at the same time, we need to let people know that it’s not ok to be spoken to like that. We need to set a good example for our juniors, to help change the culture, and also to preserve our own self-respect. My reaction was disappointing (at least to me anyway). How should I have done it better?

 

The DFTB team asked a few docs whose opinions we value greatly – how should you respond when someone at work is rude to you?

Here are the collated answers and themes from: Dara Kass (DK); Vic Brazil (VB); Simon Judkins (SJ); Damian Roland (DR); and Natalie May (NM).

 

Most people aren’t actually horrible people who want to see you suffer…

In the hectic nature of acute medical practice, clinicians can become tired,  hungry or the deadly combination of both. This can lead to frayed tensions and communication challenges. Sadly it’s often the case that rudeness is a part of normal process, rather than an unacceptable professional dynamic. DR

And sometimes, it’s possible it wasn’t meant in the way it came across…

There are many perceptual challenges around ‘rudeness’ as there is no strict definition of what it actually is. You know it when you see or hear it, but can’t necessarily always describe it. I personally believe that many people honestly don’t believe they are being rude, or if that is being too charitable, that the impact of the tone of their voice or choice of language isn’t considered. DR

We all have plenty of everyday reasons to feel some anger at work…

Usually the person is rude because they are frustrated, either with the system, the medical issue or their own lives. Rarely, the patient’s rudeness is just a personality disorder, and then I just try to interact with them as little as possible while delivering excellent care. 🙂 DK

As a senior, if this rude behaviour happens, we jump on it early, but it is also very important to listen to both sides of the story; there is often a tale of grief/stress on the other side which we need to also recognise and support. I don’t think there are many true asses out there, but many people who feel unsupported and vulnerable. SJ

Try to look on it in the most positive light and give them the benefit of the doubt…

Follow Jenny Rudolph’s #WTF2WTF … take a breath and think why? Trying to be generous in possible motivations might help. VB

 

But if it’s clearly rude, then we really need a strategy on how to deal with this. The key is to reframe is – move away from it being about the words they used or their tone when they spoke to you and try to find some common ground…

I am rarely responsible for the cause of their frustration but try to validate their experience and see what I can do do diffuse the issue. DK

Try to keep the focus on the patient i.e. both parties needs to keep the focus on the patient and not get lost in a personal dispute…

Frame all conversations with colleagues in the context of the patient’s needs – and believe first and always that your colleagues have the patient’s best interests at the centre of their intentions. NM

It’s also important to acknowledge the positives. Being kind and professional make for a happier work environment for all…

Emphasise how important good behaviour is e.g. ‘we really want to get along with our work colleagues here’. VB

And an important point to consider is that being right and being rude are two separate things. There will be times when something doesn’t go smoothly, and it might be your fault. The person being rude may be right i.e. you did indeed do something wrong, but that doesn’t give them the all-clear to be rude…

Separate the issue from the rudeness ie the person being rude might actually be ‘right’, but the conversation should clarify that the issues are separate and being right doesn’t justify the rudeness. VB

Debate around patient care is vital, in fact it is an essential element of patient safety. However, there is no reason the tone of that debate should cause discomfort to those having it. DR

 

There will be times, where you need to just confront the problem and ‘call it’. Choose your language carefully…

Use words like ‘disappointed’, ‘surprised’, and ‘what a shame’ VB

I tend to call things out, “I’m really sorry, but I don’t think I deserve to be spoken to like that. I appreciate your different point of view but how can we resolve this in the best interests of the patient.” Written down, playing the ‘patient card’ sounds glib, but in practice directing attention towards the one thing you have in common with the other person tends to clarify thinking. DR

When confronted with rudeness, pause – count to five in silence (it might need to be ten!) – then prompt reflection (the sentence I’m trying to use is “you might like to think about how that came across”). NM

It’s tough when your not expecting it..my responses vary, but usually involves highlighting the unprofessional behaviour, asking them to reflect and continue the conversation when they are ready…like I do with my teenage boys! SJ

 

‘Calling it’ doesn’t mean start an argument with them. Otherwise that defeats the purpose of your response…

Avoid interrupting or talking over people who have already escalated their behaviour – this fire will usually burn out on its own and is best countered with coolness, not more fire! NM

If rudeness/hostility continues, use graded assertiveness or giraffe feedback to shift focus to immediate needs and patient safety. Rudeness is potentially a patient safety issue. NM

 

It might not be appropriate to respond at the time for a multitude of reasons, and that’s ok…

There is nothing wrong with having the conversation later (and in many respects it might be better)….keeping the ‘marriage counselling’ lingo focused on behaviour and impact -“when you did x, I felt like y” VB

 

You don’t need to perseverate on your own about this, speak to your colleagues. They’ll all have been in a similar situation.

Consider cold debrief after such incidents with a trusted colleague and appropriate escalation as warranted by the incident (this will vary). NM

There is also nothing weak about others having these conversations for us, at least to open it up…. “My intern is pretty upset about a discussion you guys had. I truly don’t know what happened , but the impact was pretty bad . I thought you’d like to know as I doubt that was intended …..” VB

The other approach we use with our DITs is to suggest that “ it seems that we aren’t going to agree on this issue, so I think we should end this conversation. I’ll ask my Boss to call your Consultant and they can discuss a solution “. SJ

 

These lessons shouldn’t be just for one someone speaks rudely to you. It’s our job to look after our colleagues too…

Calling out rudeness when witnessed is also vital. As a senior clinician while it is easy to pretend you haven’t overheard conversations, letting things go because they don’t directly affect you propagates a culture in which the status quo remains acceptable. DR

 

Sometimes, your response will make the person realise they were rude. And they might even apologise. Allow them to do so!

Allow space for insight and apology – if the person being rude apologises, accept the apology and move on. Harbouring negativity helps no-one. NM

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About 

Tessa Davis is a paediatric emergency registrar from Glasgow and Sydney, but currently living in London. Tessa tries to spend time with her 3 kids in between shifts. @tessardavis | + Tessa Davis | Tessa's DFTB posts

Author: Tessa Davis Tessa Davis is a paediatric emergency registrar from Glasgow and Sydney, but currently living in London. Tessa tries to spend time with her 3 kids in between shifts. @tessardavis | + Tessa Davis | Tessa's DFTB posts

10 Responses to "On Rudeness"

  1. Gaby Blecher
    Gaby Blecher 2 months ago .Reply

    I’d stil like to know the best response once could give.

  2. Miss Marple
    Miss Marple 2 months ago .Reply

    This is something that we ED docs get lots of from inpatient teams. Very frustrating and demeaning. And often times, just from the shock of it all — that someone can actually be that rude, we’re often left speechless and the rude registrar just walks off feeling happy about himself while whenever this happens to me, I’m dejected for pretty much the rest of the shift 🙁

    • Tessa Davis
      Tessa Davis 2 months ago .Reply

      Yes! Exactly. They probably don’t give it a second thought, while we are torturing ourselves about what just happened. That’s where we need to change our actions, and make a plan for how to respond to these incidents appropriately. But it isn’t easy.

  3. A / Prof David Mcdonald
    A / Prof David Mcdonald 2 months ago .Reply

    Difficult..I would report to a senior colleague. The consolation is that what goes around comes around,but if this is an individual with a pattern of such conduct it should be brought to his supervisors attention by your own senior staff,as it is harmful to patient care and staff welfare,and an unacceptable professional standard.

    • Tessa Davis
      Tessa Davis 2 months ago .Reply

      Thanks – unfortunately I think this happens regularly. But you are correct, that in some people it may be a pattern and needs to be reported. In others, there may be many factors contributing to them being particularly annoyed and causing them to be short on a given day. Either way, you are right that it’s unacceptable.

  4. Chris
    Chris 2 months ago .Reply

    Great resource here:
    https://www.civilitysaveslives.com

    Our prefrontal cortex responds to rudeness, no matter how ‘tough’ we are.

  5. Derek Louey
    Derek Louey 2 months ago .Reply

    Trying to change teaching hospital culture is a difficult thing to change due to the high turnover of staff with rarely the opportunity to get to know one another yet at the same time a need for all the moving parts to work smoothly together. This leads to rising frustrations and increased workload for everybody; and unfortunate interactions such as these. There is also an argument that the loss the RMOs lounge in many hospital removes an alternative outlet for the development of civil collegiality

    Alternatively, one could confront the concern head on, get the other person’s perspective and develop a strategy to prevent future incidents.

    Although rudeness cannot be justified, to extract an apology before his explanation might feel like a temporary victory but ultimately what he is asking for understanding and for the issue not to occur again.

    With courage and humility, ‘Sorry, I don’t quite understand. Was there something I did?’

    Perhaps the orthopaedic registrar had the opportunity to book theatre for your patient straightaway but now had to defer them to the end of busy list the next day. Maybe he was uncomfortable with leaving the angulated limb in that state overnight Maybe it was going to be difficult to convince the anaesthetist to do a GA on a un-fasted patient for a non-critical procedure. Perhaps the ward was full and this might have avoided an overnight stay.

    The conciliatory response could be, ‘I didn’t realise how much impact this might have had. I’m sorry. I should have reminded mum not to feed the child. I’ll make sure it won’t happen again. Your comment really confused and embarrassed me’

    I would almost guarantee a sheepish apology from the registrar and probably increase his respect for both your admission and your maturity. Your actions themselves might also teach him a lesson or two that not all mistakes are perverse attempts at making his life miserable.

    Heap a few more burning coals on his head. At this point, you might even propose a solution to prevent further occurrences, ‘Do you think we should put some signs up in the waiting room’, ‘Should we remind our triage nurses to routinely advise patients to remain fasted if they have an extremity injury until otherwise told not to’. ‘What do you think?’

    It might seem like hard work to take the onus of responsibility to create safe culture but I don’t think having hospital administrators sending out memos (or viral Tweets) about ‘playing nicely’ is the solution.

    • Tessa Davis
      Tessa Davis 2 months ago .Reply

      All great suggestions, thanks. The culture in teaching hospitals has to come from the senior staff – it shouldn’t be an excuse because the junior staff changeover regularly. There are plenty of hospitals (including my own) where the senior staff model positive behaviour, and also show juniors how they react when people are rude to their team. (That’s the senior medical staff, rather than the administrators). This in turn shows juniors how to expect to be treated and can help with strategies for how to respond. It’s still a challenge for juniors who are new to the job though.

  6. Bishan Rajapakse
    Bishan Rajapakse 2 months ago .Reply

    Hi Tessa, this is such an important post. I can only imagine how it left you feeling. If it happened to me I would have been left with a sense of humiliation, and uncertain shame, anger, and fear about future encounters. It has happened to me at many stages in my career, and continues to occur……For this reason it is such brilliant post. Thanks for sharing, along with the commentary.

    Its hard to really know the source the attitude conveyed, and what the intention was behind it. I could be sheer ignorance, indifference, malice or a combination. For me, sharing these experience with trusted friends, colleagues and mostly mentors has been the way to deal with the emotions surrounding such encounters.

    One phrase I have heard recently championed by Shanina Briganza was “I regret the communication we had the other day” – I’ve thought I would try that next time this occurs. However, I haven’t yet tried this phrase myself, and I wonder if it would work in this encounter? I’m not sure. When it comes to the speciality teams, often I believe the encounter is very imbalanced, for as an ED doc I’m trying to do my best to help the patient get to definitive and ongoing care, and in that I need the collaboration of the speciality. For the speciality they sometimes don’t see the value of the person referring the patient that makes up the bread and butter of their work.

    Anyway – I don’t have much to offer, but to share in the frustration and sadness of such encounters, and to rejoice in the fact that conversations about this type of unhelpful behaviour are now becoming more and more commonplace. Thank goodness. Cheers for the post 🙂

    • Tessa Davis
      Tessa Davis 2 months ago .Reply

      Thanks Bish, I appreciate you commenting. You make an interesting point about the imbalance in a specialty v ED encounter. It’s not something I’ve considered before but clearly is an important factor in the interaction. Also, I like your suggestion from Shanina Briganza – I might try this next time.

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