Thanks again Scott from bringing up this very interesting topic. I am a French ER physician with a 12+ years experience and we too are often facing this type of behaviors. Two years ago in my department, we reached a point where some of our trainees were scared of calling some specialists (mostly surgeons) for fear of being in a bullied. It was mostly towards ER trainees or young ER physicians. And that is where we thought it started to become dangerous for our patients, when doctors where avoiding doing the right thing for fear of being bullied. Some of us (incl me), being of Latin descent, started with an even more inappropriate behavior, hanging up the phone in their face and calling back just afterwards “sorry there is an inappropriate behavior filter on this phone”, or being aggressive in return. Which of course made us feel better for a while but didn’t help the situation nor the patient. So we started to work on that track. I talked to some of my friends which are surgeons or intensivists, and which are usually very nice people in their private life but have a terrible reputation of being dragons in the… Read more »

Dear Dr Weingart.
I am very happy that somebody speaks about those topics that are also a very important part of wellbeing.
I am a prehospital em doc, family medicine and this year I enrolled in family and relational psychotherapy study.
I find one thing very useful in defusing an angry consultant. Its apology. Not a guilty, i-make-myself-small, sorry to disturb you, like. But empathic apology which I make because of myself. It is hard to find that in a moment before reacting, but if you do results are surprising.
An example would be: I am really sorry that my consult upsets you, I understand you are very busy…
If you try that in road rage its like you take a substrate for anger from a person and they lose their ground and cannot react to you anymore, because you dont give them the fuse to light.

Anyway, would be happy to hear your thoughts and looking forward to next podcast!

Klemen

Gentleman I really enjoyed this talk. I’ve presented on this subject and struggled with my response to rudeness. I historically have been a very visceral responder and have many examples of scenarios where in retrospect my counter aggression was misplaced. I think EM attendings are often treated as residents. This culture in part relates to our notably non-hierarchal system where staff are always present in the Department and our sterotypical relationships with residents is more collegial, friend-like. This may seem a positive thing but its not when assholes are involved. We have to disrupt the daily activities of others to do our job… imaging, consultations, admissions etc. Being patient centered means that sometimes we are going to piss people off and conflict avoidance CAN KILL. These are my techniques to “Why are you calling me the CT isn’t done yet” 1. Understand you will not change behavior during the initial dialogue (or perhaps ever) 2. Restate your ask as a non-open ended statement and close it definitively. Develop a script: “I know you’re busy, let me clarify there’s a 45 yo with a recent diagnosis of diverticulitis who is hypotensive, tachycardic and has diffuse peritonitis. He’s had xyz done. This… Read more »

Thanks so much for these podcasts on rudeness. I’m still in my first few years of ED training (having practised in other areas prior) and find this a very difficult topic. I’ve experienced rudeness much more frequently in ED than any other area I’ve worked in and I think this is for 2 reasons; firstly because some, not all, but some, hospitalists think that we’re not ‘the specialists’ and our medical opinions are not worth anything. And second, because the specialist teams perceive us as creating more work for them when they’re already stressed and busy. Being made to feel like either (not having a reliable medical opinion or being work creators) feels very insulting to an ED doctor and there-in lies the perfect storm. So how do we deal with this? And more importantly be good patient advocates to get them the care they need? I’ve heard many times ED doctors being told by other ED doctors just to ‘brush things off’ and ‘roll over’ in order for an ‘easier life’, but I think consistently doing so can really degrade your sense of self-worth over time, which leads to anger, bitterness, depression, burnout and ultimately poor patient care. It’s… Read more »

Always great to hear my old colleague Pete speak.

Question for the two of you “is being rude ever appropriate”. And what constitutes rudeness?

As both an EM and Intensive care physician I see lots of Disposition-EM being practiced. Humbly I propose that a consultant should be utilized to further the patients needs; after exhaustion of the skills within the scope of ones specialties,

Using consultants to lessen ones workload or disposition angst – I would suggest is rude – albeit in a passive aggressive manner. This is becoming the culture – the drivers of which are many.

Always happy to help when needed. We all have EM colleagues who over utilize consultants for the reasons above. I think this also needs to be owned by EM. Thus rudeness is a two way street – just practiced differently.

As my colleague and friend, Pete Brindley, often says to resident during sign over rounds. “Call me if you need me; but need me if you call me”.

Cheers,
Stu