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 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 »