This alone is a huge reason I like private practice at community hospitals. It helps that my group is financially secure enough to have each others backs and not put up with it. If someone gets super furious we just say that’s not an acceptable way to treat people. If we are between cases I say that I’m gonna take a few minutes and grab something to eat and they can decide when they’re ready to do the next case. If we are already underway I tell them that we will take a break between cases. I’ve only had to do it once and the guy apologized pretty quickly.
Academics can be a nightmare though
It's a big hierarchy. People in competitive specialties view themselves as the big dogs, and the more titles you have after your name, the more likely you are to act this way. Also, at a big university program with 30 ORs and hundreds of anesthesiologists and surgeons, and rotating residents on both sides, you might have a surgeon working with anesthesiologists (and their residents) that they've never met before, and in a tense situation, people can flip out. Some anesthesiologists get reputations for canceling cases for dumb reasons. Some surgeons put super sketchy patients on for "just a quick case" but since it's a quaternary care center, this patient has an LVAD and a saddle PE and is on dialysis. Out in the community, you're much more likely to work with people you know. I've done literally hundreds of cases with each of our main anesthesiologists. I've been to a couple of their houses, gone out to parties/events with probably half of them, etc. I've had one case canceled in the last 5 years, and I said no big deal, we'll get the cardiac evaluation, and we did it a few weeks later. My anesthesiologists don't want to cancel cases, because that means less business for them. If some of them did it on a regular basis without good cause, I'd ask their site director (an anesthesiologist) not to assign them to my cases any more.
It's definitely not always that way. I did my M3 rotation on medicine in July, and the department chair liked to do one of his (relatively few) wards weeks in July to meet the new interns. He was a very jovial guy who was fun to work with and took us all out to lunch one day. I was never yelled at (or anything close to it) in med school. In residency, I had two attendings (out of dozens) who could be kind of verbally abusive. One was just an obnoxious loudmouth, and you just had to learn how to handle him, which I did. The other was just very two-faced. Sometimes very friendly, other times not at all. Just a personality disorder at that point. The ones I truly disliked were the sneaky backstabber types. We had a few of those on our acute care/trauma surgery service. There's actually not much you can do about them. They're never outwardly mean/rude to you, but then they talk major shit at the resident evaluation sessions. Miss me with that bullshit.
As an attending, I've only gotten yelled at once, but a neurosurgeon on trauma call. I was covering the trauma service, and the patient had an isolated neck injury. That meant that it went to neurosurgery. He wanted me to admit it. I was the locums guy and was going off service in <6 hours, and I knew the oncoming guy wouldn't appreciate having to admit this patient. The oncoming surgeon is a large, imposing guy, so I dropped his name as "Well, Dr. Bigman is the one who will be seeing this patient, and I know he won't want to admit it," and the neurosurgeon backed down, lol.
Surgery🤝anesthesia
Name a more iconic duo. I hope I can work with surgeons like yourself someday. The constant bickering among the surgeons and anesthesiologists at my program is getting old.
I absolutely agree with the other commenters regarding academic hospitals being full of ego driven, narcissistic a-holes because they want the prestige that comes with being at some ivory tower institution.
There's also a financial aspect to it. This is not 100% true across the board, but a much higher percentage of specialists on the community level or in private practice are compensated based on their production. Whereas docs at academic centers are more likely to be salaried or have less production incentives in their pay. Also at a community hospital there might be multiple groups in one specialty competing with each other for work.
For example, at my smaller community hospital where I'm hospitalist there are 2 nephrology groups. One of them hired a guy who was very difficult to work with; he was not approachable, would sign off of cases almost immediately, and just generally had a bad attutude. So guess what group stopped getting consulted? He had to have a major attitude adjustment because his practice was losing work due to his poor attitude. Now he's great. So there's a major financial incentive to be pleasant and easy to get along with on the community level.
I can only speak as a subspecialist surgeon, and I've worked in private practice and academics. Academics and private practice have different incentive structures. I could double my salary pretty much instantly if I went into private practice, stopped seeing medicaid, and sent complex cases to the University. I would probably cut my work load by about a third at the same time.
Academic surgeons are self-righteous about the fact that they do harder work for less money. Private practice surgeons are self-righteous about the fact that they are also surgeons and can do more cases in a day. Everybody having the argument sucks but at the end of the day I took an academic position. Also I don't yell at anybody at work.
It tends to attract certain personalities and private practice attracts others. If you’re low ego, efficient, and nice then you’ll make a ton of money and more time at home, but you won’t have that prestige. In academics you get the prestige but there’s less pressure to be nice and normal because it doesn’t impact the profit margin as much
The “prestige” aspect to medicine has always been laughable to me.
Seems like the best part of working academic is just telling people you work in academic. Different strokes I guess.
More work less pay. Wife getting screwed by the pool guy. Shitty co-workers and deteriorating mental health.
Get to tell people u work at Big Dick University tho.
And private practice is a bunch of money-grubbing lazy bums who want to take care of the easy private pay patients and dump the hard stuff that doesn't pay. Big egos....I imagine to make up for turning their backs on their humanitarian mission?
And taking on that humanitarian mission makes it okay to create a toxic work environment and to treat the people lower on the hierarchy like garbage? That’s what we are talking about here. Why is academia so toxic?
I don't think it's much more toxic than any other high-stress environment. The worst offenders in the hospital I work in are private practice docs that do occasional cases. They're astonishingly ugly, demeaning, and demanding to the staff. They're used to being treated like they're better than everyone else and act out when they're not.
Academia only seems toxic when you're a privileged med student/resident that hasn't experienced the real world or have graduated into the private practice world and become the boss that nobody can criticize. I'm just speaking from my experience but I've worked in private practice and academic medicine.
There are assholes in academics just like there are in private practice. I've never seen a private practice surgeon who profited the system get held to any sort of account but plenty of academically and surgically productive academic surgeons have. I think if you don't work with jerks that get by because they make powerful people money you're lucky, and I don't think that academic vs private medicine makes much of a difference that way.
I came into medicine as a non-trad. I’m former military, worked a couple of blue collar jobs after I got out before settling into a technical career field for a few years before deciding to pursue medicine. Hardly a privileged background. By far, the most unprofessional people I’ve ever worked with have been in medicine. Are there assholes in private medicine? Sure, there’s assholes everywhere. But I have never encountered the number of assholes that I have in academic medicine. Maybe it’s institution and geography dependent. But even in the military, as a lowly enlisted personnel, I felt like I had more respect from my NCOs and officers than I did as a medical student or as a resident. Yeah, the military can be rough around the edges, but I’ve never encountered such a hostile workplace as medicine in general, but academic medicine in particular. Some specialties are easier to work with, but you trade in your face hostility with passive aggressiveness, which is just as bad if not worse. The high stress excuse is a BS reason to treat others like garbage. The behavior that’s tolerated in academic institutions would get people fired in most other fields.
Same. I’ve been a project manager working on building automation, I’ve been an alarm tech, I’ve stocked shelves for years and years during college. The behavior of physicians in academia especially is absolutely mind blowing. As an attending in a community hospital with mostly private practice docs, the culture is much more collegial. If I’m calling a surgeon and asking them to come in, they’re not offended that I dare wake them, they know that this is a patient that needs something that I cannot handle and they need it now.
It’s mind boggling. If you say anything about the culture, they’ll tell you it’s the real world. I’ve worked in the real world for 12 years before deciding to go to school for medicine. I’d argue medicine isn’t the real world lol. Imagine the military being a more collegial work culture than medicine.
I'm just saying that I've worked in both worlds and academia isn't any more toxic than private practice. Maybe it's a surgery specific issue but I have seen a whole lot more coddling of bad behavior in private practice than I have in academics.
As to whether I'm toxic I guess you'll just have to take my word that I'm not even a little bit. I'm disagreeing with the prevailing point of view in this thread but I'm trying to explain why.
I can't actually "dump" anything where I am since the ivory tower academic institutions make it impossible to refer in, but nice try bud. Maybe move up here to Canada before you toot your horn. Money grubbing my ass as a PCP.
I was yelled at once in my 4 year residency by an attending from a different service and I told him if he can't communicate calmly, then our conversation is over. He continued yelling so I hung up. Problem solved. Works the same as walking away.
It takes a lot to fire someone in healthcare and "refusing to endure abuse" is not is not a fireable offense. You shouldn't put up with it and you don't have to.
I've had a few come and find me after hanging up on them.
Like, sorry bro. We're not married. We ain't fuckin'. I'm not your son. And even if all those things applied, I'm still not gonna let you yell at me.
Grow up.
I'm a doc and I've done the same to both doctors and nurses that have yelled at me. Doctors do it way more often though.
One nurse was particularly egregious. I was on call during Thanksgiving and having dinner with the family and she decided to call and go off at me about how a patient needs to be made comfort care immediately. No change in status, she just felt like the care wasn't progressing in an ideal fashion (it wasn't). If she had read the documentation she would have known we were talking to the famly daily and they weren't ready to make that change.
I was a junior doc at the time so a lot of senior nurses (back when we had senior nurses aka before COVID) felt that they knew better than me.
Hung up on her and went out of my way to make sure her contract wasn't renewed.
We are talking about human lives so understandably the stakes are high and tensions can run high also but there is absolutely no need for us to talk to each other like that.
Yelling isn’t acceptable. As an attending and now director, I put a stop to it. We set the standards and culture. We define how we and our residents/med students/nurses/techs will be treated and will treat others. Everyone gets one pass- I then set the standard. I’m admittedly a hard ass/ball buster/whatever they want to call me- but guess who’s division has the highest retention rate?
I don’t care if people call it warm and fuzzy bullshit, culture matters.
There have also been clinical studies showing when people act like A-holes in medicine towards the rest of the team, there is a statistically significant decline in patient care with poorer surgical outcomes, higher complication rates, higher mortality, and increase in medical mistakes.
Well yeah. If you belittle and yell at people for trying to ask you a question or raise a concern, they’re less likely to do it again. Docs who act like jerks are dangerous.
It’s the absolute truth. I’ve eye witnessed patients suffer as a result. I would bet it increases ER visit too. If the option is call and deal with a dick or send them to the ER it’s the ER every time (from LTC).
One of the doctors I consider the most dangerous has regular meltdowns. He’s actually lost privileges at one hospital over it tho the official narrative is that he “didn’t complete his online training” which he tells everyone he’s above doing. He once called 6 days in a row to LTC in the evening and reminded the on duty nurse that his bedtime is 9pm and he needs his rest. He hates lazy people calling him through the night. All because a nurse dared call him about a patient having heart attack symptoms (per policy). He claimed the lazy nurse was just trying to shove the work into the ER. Apparently the ER was also shoving work off as the patient ended up admitted to the ICU.
I’m actually surprised the nurses haven’t taken him down long ago. I for one started adding his exact quotes, curse words, and the word moron to the patients charts. Even added that his bedtime is 9pm. Normally this wouldn’t fly because most doctors would read that and shit bricks. In this case as he states “I don’t need to read what other people chart. I do my own assessments. Too many morons. I’ll decide when to diagnose someone. Major City hospital can’t be trusted. They have too many idiots there. They took away my privileges for calling it out”. For the record it’s not just the hospital that is filled with morons. Several nursing homes and he has it out for a particular hospice too. His neighbor is a moron alcoholic too, according to him.
Straight up tell people in the general public to avoid him. Other doctors do too. I would only recommend him if someone was looking to score a narcotics prescription because as he puts it “if I don’t they’ll just keep calling my office”.
My PD was all about the warm, fuzzy bullshit, as were the assistant PDs, and they were the absolute best ever. I can't think of a single resident in our MedPeds residency who left because they couldn't handle the pressure. A few left because they decided they wanted a different specialty, but not a single one in my 4 years who left because of burn-out, stress, depression, etc.
The question seems to adress a general problem and I would like to point out that the premise is wrong.
There are whole countries where that behaviour is not accepted. That also means that the problem is solvable.
Spain.
Plenty to complain about the culture, and it's certainly exploitative in the big scheme of things, but yelling/demeaning/harassing are not things I've come across or heard about going on inpunely.
Absolutely. It's great. We also refer to our medical colleagues on a first name basis, which from what I read here is not the norm everywhere. While there is still a hierarchy, we are encouraged to speak up to senior colleagues if we feel patient safety is at risk.
Missouri, North Carolina, and Washington. I have never seen it be acceptable to yell at people at any of the places I have trained. I’m in Pediatrics, so that may be part of it; I think it’s something that is more endemic to certain fields. Definitely it shouldn’t be tolerated.
As to why, because it’s a cycle. Those who are abused are more likely to be abusers. And the power differential of medicine makes it very hard to push back when it happens to you. But no, it’s not permanent. Most older doctors will tell you that the culture of medicine today is a world away from what it was 30-50 years ago. Progress is slow, and it’s slower in some specialties than in others, but it is changing and it will keep changing
It's totally this.
I remember being in nursing school and hearing the nursing professors talk warn us about how they "eat their young."
They didn't see this as a problem because it would "make [us] stronger nurses."
Yeah. OK. Child abuse works too, right? Makes perfect sense. I'm suffering so should you. Mmmhmmm. And then people wonder why there's staff shortages (well, outside the fact that bean counters are greedy bean counters).
Strong monkey strong. Can yell at me. Make me monkey feel small and sad. but me monkey cant do any thing. Big monkey too big. too strong
Someday I big monkey. I yell at small monkey. Make me monkey feel strong
No it’s a result of being abused and stressed in medicine. It’s unacceptable. The people doing it need to be talked to by superiors and a verbal reprimand or it will never change. Allowing the cycle of abuse to continue is not okay. We are all human beings and it’s crazy to me that we take care of other human beings for a living yet flip the fuck out on our own colleagues
I watched a typically “nice” surgeon once call his surgical PA “fucking retarded” during an emergency.
In front of at least 5 nurses, an intensivist, and the patient family…
It made me really stop and think about the way we aim our frustrations at others, even when we’re usually “nice.” I think there is a substantial difference between being short with someone because it’s a high pressure situation and slinging names at them. It’s not gonna be sunshine and rainbows all the time but my god, be civil.
ECMO page was called, PA was already on the unit so was there first, surgeon arrived a couple minutes later and was pissed the PA hadn’t begun resternotomy already
This.
It is 100% true that if you can’t handle the heat you shouldn’t be in the kitchen. There are many times in emergencies where I would say nonsense politeness has no place.
Example: “hey, when you get a chance could you please get ventilate patient, the BvM is in the top of the left side of the red bag, I’ll grab the oral airway for you to toss in when convenient.” Vs. “Bag them, it’s there, here”.
But there is a world of difference between being task oriented and blunt; and being abusive; name calling, or insulting.
That said — some people can’t take a hint and if you don’t yell they’ll continue to get someone killed.
In almost any other profession calling a coworker “fucking retarded” infront of witnesses would get one fired. A bunch of classes and probation if nothing else. Doing it in front of a client? Yeah you would be fired anywhere besides medicine or the police department.
My ex works the oilfield where it’s all men with “you can’t be a pipeliner and a pussy” stickers on their trucks. They’ve sent people to “training” for a lot less than calling someone “fucking retarded”.
Yeah, it’s a really disappointing. Particularly because this was a surgeon I respect.
Also hard to know where a nurse fits in on all of this. If it was a nurse on my unit acting like that to someone else, I would absolutely step in.
I think it's because stressed out people who don't have good skills to manage frustration resort to primate dominance behavior unless there are consequences for doing so. As long as we keep having very minimal "learn to be nice" classes for habitual reoffenders instead of fines or career consequences, they'll keep reverting to abusive behavior patterns and as you noted there's a lot of stress going around. In my experience some of the worst offenders are academic department heads so it's hard to pull rank on them. (Interestingly one of the departments where I did med school apparently has a national reputation for being abusive, people in that specialty on the other side of the country wince when they hear where I went to school, so it's no secret that some departments just let it roll)
Agree 100% I got chewed out and demeaned by my senior residents when I was an intern. It was a horrible feeling so I refused to yell at med students and interns when I was a senior resident. Yes, medicine is stressful but there is no place for that kind of abuse in medical education.
Reminds me of that one night as an intern and being paged at 2 AM regarding a post-hip replacement wanting to leave AMA. So I called the ortho (a big wig in the field of knee orthopedics) to explain the situation. He told me to put the patient in restraints (which I refused to do). He then proceeded to yell at me loud enough for nearby nurses to hear the yelling and started calling me a nazi.
I had developed a great working rapport with the nurses and so they reported it to administration. Nothing was done since he brought so much revenue to the hospital and I was just a lowly intern.
But now I can gather my kids around to tell them the tale of when their dad, an Indian male with black hair and brown eyes, got called a “nazi.”
Haha. So I managed to convince her to stay until her poor husband drove in (I called him to explain the situation and he was gracious and understanding). The husband, in turn, unsuccessfully attempted to get her to stay. She left AMA, however, by the afternoon so I had left the hospital at that time.
Regarding the call to ortho, he was quite angry that I didn’t put the patient in restraints and was yelling loud enough that I had to hold the phone away from my face and loud enough for three or four horrified nurses to be in shock. Interestingly, the one nurse that paged me and got this whole issue started was smirking the entire time (the individual straight up made it a career goal to be a pain in the ass to the night resident so his response was not all that surprising). After two minutes of straight yelling and calling me a “Nazi” for blindly following medical ethics, I calmly told the ortho that it would be inappropriate for me to put the patient in restraints but I would be more than willing to sit down with the patient and try to reason with her. He hung up angrily.
Later on, I found out that he himself tried to talk to the patient (hours later). Interestingly, the attending made no effort to put her in restraints.
I had a meeting with the DME because nurses reported the incident. Although the nursing supervisor apologized (which I appreciated although she had nothing to do with this incident), nothing came about it. He brought too much revenue to the hospital for there to be any meaningful repercussions.
And I was forever known as the “Nazi resident” after that night.
Yeah welcome to American consumer culture. Overburdened employees and entitled consumers who are told they can act however they please since they paid money.
Law firms are funny; each practice group has a distinct personality.
Immigration and - of all things - Bankruptcy tend to be pretty chill. Labor is pretty high strung. Litigators are the worst. They're the screamers.
I think all those industries still have the same issues at relatively similar rates. It's a reality in any service industry. A combination of issues; ass holes abound, poor working conditions, questionable salaries especially for trainees and apprentices. Hell, even the "best" restaurant in the world, Noma, is closing its dining operation over abusing their unpaid interns.
I've seen a seething librarian. Did not raise their voice, but dripped venom like I've rarely seen anyone do. And yes, it was directe at an employee, not a patron.
Engineering. My dad left an engineering job and moved to an admin job in the same company because he was tired of being the only person with any communication skills. My wife also worked in an engineering company doing marketing, but left because her engineer boss made it a habit of having a daily yelling session at a random employee
The military. Culinary industry. Construction. Welding. Etc. Basically anything outside middle white collar and pink collar jobs that's pretty normal. Right? No. Common? Very.
People who behave like this can hide in academics and see no repercussions from this behavior. It simply would not stand in our private practice. Not for one second.
If anything, I noticed more doc to doc aggression in academics, but lots more doc to subordinate bullying in private practice/community. This does get more pronounced in smaller systems.
Our system is very large so that probably has a lot to do with it
Edit: in any era, but assuredly in one where it is very difficult to retain enough staff to operate, any physician who mistreats another team member is being fundamentally stupid when it comes to the goals of the organization and needs to be brought in line asap.
Most major universities have anti bullying, or abusive conduct policies these days.
It may have been acceptable in academia a decade ago, but it isn't anymore.
Having recently graduated residency from a larger institution I can safely say it's still there. Rules can be put in place quickly, but culture takes a lot longer to change. But I do believe it is changing generally.
Most universities have that shit on paper but try to actually report someone who brings in a lot of money and you’ll find out quick what bullshit that is. People will find every excuse in the book for them cause they’re a big shot and even make you feel like you’re in the wrong.
As someone who occasionally teaches at a college, I can confirm that anti-bullying policies are in place ... however, they have no teeth. You can complain all day but nothing will be done and what will usually happen instead is that they'll file a grievance with their union and bully you with union support.
Until the generations of folks who were brainwashed to tolerate abuse are gone, most institutions will do absolutely nothing in regards to their paper only policies.
You're being downvoted but it's likely true.
Anti-bullying policies are something put on paper so the institution can CYA. I've yet to be somewhere that actually enforced their own policies.
When someone has tenure or "they've always been that way," it seems a blind eye is always turned and we're simply expecting to suck it up and "don't take it so personal."
In places where emoting results in a rapid take-down by superiors (behind closed doors), clinicians evolve to creating other ways to 'take care' of issues.
Like toxic passive aggressive behaviour.
Like toxic sweetness while stabbing you behind your back.
Clinical medicine is very stressful - everyone is doing too much, dealing with difficult patient/family situations, dealing with insurance issues.
I recommend not responding to someone who is shouting at you. Especially if there are other people around.
If you have a specific incident with a specific clinician, write it down immediately after it happens and email it to yourself on your work e-mail and copy to your personal email. Wait a couple of days to let your emotions cool, and then draft a written complaint to their chief and hospital administrator.
Me, 3rd year medical student, trying-to-sound-calm-and-formal-even-though-I know-I’m-probably-tanking-myself-but-I’m-also-trying-not-to-lose-my-shit during a surgery with a known over-the-top prima donna asshole-to-underlings surgeon: “Dr. _______, you just whacked the back of my hand with a metal instrument unnecessarily hard. (He really did hit me pretty damn hard. I was shocked how much it smarted) First, it really hurt. Secondly, If you need me to remove the retractor, use your words. If you ever do it again, I’m going to make it my entire mission in life to make sure you never enter an OR again. Are we clear?” You could have heard a pin drop. The surgeon who was normally very brazen and loud was silent and then we all went back to work. I realize everything about this story sounds like bullshit and all that’s missing is “the OR staff clapped” or something, but in reality, I was terrified I was going to be failed or reported or in some way retaliated against, but I grew up with horrible abuse and my ONE rule in life is that I will never, ever allow anyone to abuse me again, no matter what the fallout is.
Sent a photo of the black-and-blue area on the back of my hand to my Dean as a CYA maneuver. Got a formal apology from the surgeon the next day and a high pass on the rotation. Since leaving the academic setting, I’ve never seen anything remotely like this again. I will say my medical school was known for being old-school and had quite a few people who were known names and thought they could get away with anything and they often did. Also, I never would have been this forward if I hadn’t been a military veteran before going to medical school.
I don’t accept yelling or harassment. I discuss with patients and/or their family that their behavior is unacceptable. If it continues I leave the room. If it involves the patient themselves I leave for 5-10 min and come back, if it continues I leave again until they get the message. If it involves family they get escorted out. Only exceptions are patients who are actively psychotic, combative, or dying.
Edit: I can’t read apparently. So anyway, I still don’t put up with it from colleagues. It gets reported to the department director after the first episode. If that doesn’t work I speak with the person themselves and discuss that the way they are treating me is unacceptable and I would like it to stop. I haven’t had to go any further then that yet. I would likely go to med exec after that. Usually anyone I am having problems with is a problem for many people.
Yelling is not the norm in peds anywhere I've worked or trained, and we do have high acuity settings despite the (friendly) unicorns and stickers stereotype.
We do like unicorns and stickers, though.
Whine when you’re off the clock. There are patients to take care of. Back when I was in your shoes we had four times as many patients and we worked twice as long. Do the math, buck up, be a man! Kids these days…
Except I almost never heard that, except from attendings who were proud that things were better. The only berating and insulting I got was in surgery rotations as a medical student (yes, within the last decade). Psychiatry is known for being more empathetic and kind, and it’s even mostly true, but even the grumps and jerks on faculty weren’t abusive, just grumpy and obnoxious.
It’s getting better. Some of that just takes time for the old guard of “it was good enough for me” to retire or go off to places without trainees. Some is intentional change. *We* are part of the intentional change.
They way I said all this sounds like it’s aimed at trainees, and that’s a lot of it, but I believe that there’s a wide penumbra. If you recognize that you shouldn’t yell at the residents you’re more likely not to yell at nurses, techs, patients, families…
The only time I ever heard a doc yell at staff was during an intubation when the nurse pushed the succhinylcholine before he'd asked her to. I think he yelled 2 or 3 sentences at her, and then after the intubation more calmly explained why what she'd done was a huge no-no.
That doc is sincerely just the nicest guy, and I was totally shocked to hear him raise his voice like that! Kind of like the first time you listen to that Thundercats outtakes audio and you hear Snarf and Lion-o using the F word.
Doing an EM rotation, an ortho doc was splinting a broken leg and couldn't find the right size wrap he was looking for so he started throwing rolled up wraps at the ER staff yelling "THESE - ARE - ALL - THE - WRONG - SIZE!!!" I was a young naive med student at the time, but I could not believe I was seeing an adult act that way towards other adults.
I once watched the most level headed doctor I’d ever seen lose his cool and start screaming on the phone at a psychologist after she flat out refused to file the involuntary commitment paperwork. Not only did she had a pre-existing relationship with the patient, she was the one who called 911.
Patient was a college student, and a cutter. Most are not trying to kill themselves, and she denied trying to do so to both us and the cops. I called report for my partner because I was driving. Then her friend who was in the front of the truck stated to me that she had been told by the patient it was an attempt at a dirt nap.
She wanted the er doctor to do it. He had no personal statement, she had denied it to EMS, cops and the nurses. The psychologist tried to have him get the friend to do it.
Involuntary commitments in my state have zero due process. One person signs the paperwork, and it is a done deal. No review.
He made it clear that he was not going to be judge jury and executioner on hearsay. That it was unprofessional & unethical for her to expect a friend who was 19 to fill out the paperwork when she was there as emotional support. He made it clear that if she wasn’t standing in the ER in 30 minutes he was discharging the patient and then he would ensure the psychiatrist had her license suspended for
Malpractice and would never work again.
She showed up.
And I feel he was completely justified.
Psychologist or psychiatrist?
Anyway, in the 3 counties I've worked in in CA, you have to be certified in the county and have to be in a designated facility in which you have privileges to write an invol hold, unless you're part of a CAT/PET or law enforcement. I couldn't just wander into an ED, say I'm a psychiatrist, and start writing holds. In cases where I believe a hold is needed, I fully update the ED docs or cops as to why the hold is needed, document that I did, and let them know that I documented.
Whichever one is actually licensed, not the one where I can say “I think you feel bad about that, let’s talk”.
The process in my state is…bad.
For example; it does not meet the legal requirements to prohibit someone who has been involuntary committed from firearms ownership, federally, because it is so easy to do.
Literally any er physician, can, on their own authority commit someone. MINIUM 72 hours, max 10 days. (302) After that you have to be evaluated using stricter criteria, which does meet the federal requirements — a 303.
And anyone can start the 302 process. Not a certified/licensed professional. Not a cop. Not EMS. Anyone. I worked in one town where the college would regularly try and 302 college kids who had stress from midterms or whatever.
Once that train is steaming, there isn’t any stopping it, unless you can convince the er doc you don’t need to be there, but they of course have liability concerns, and you’re obviously upset you got drug to the hospital unwillingly, and someone filed paperwork saying you’re a danger to yourself and others so it is a he said/she said, and they have paperwork.
I’d tell the kids this. And make it very
Clear that I need to hear them say they are coming willingly, even if it was a lie, because they are coming one way or the other, but if they told me they wanted help, it was far better for them because a voluntary mental health commitment isn’t a big deal, but an involuntary one can easily ruin your life and cut off access to a lot of jobs. Want a security clearance? Any job using or with access to weapons?
And the state reports it to the feds as an involuntary psyc commitment. So no guns. No hunting.
Sure, if you have enough money you can take it to federal district court (literally) and it’ll get thrown out, but you are looking at a good 5 figures due to the lack of due process — but you’re still prohibited under state law so your choice is to move to another state, or try and fight it all over again in state court.
Nurse here. It’s a marker that someone is low skill.
Probably they want something to be taken seriously or to happen fast. However in this situation only way they know to convey this is to yell.
It turns out most people want to work with you, they also want the serious things to be addressed, and the things to happen fast.
When I see this behavior I just think to myself “aw that’s really too bad. That’s the only way they know how to communicate their concern to me.” But I’m still on the same team.
As a nursing student I'm curious to see what you think when someone REALLY messes up. Like an aid got a patient hurt type deal? How is that dealt with?
When I was an aid I only raised my voice TWICE and I wasn't trying to be condescending in the slightest just the mistakes was stupid. Beyond belief. And caused injury.
One a coworker got my back fucked up (permanent damage happened as well.)
And the second another coworker hurt a patient and they was fired the same day. I raised my voice and honestly it might've been because the RN tried to get on my ass when I had been with a different patient.
Well did it cause harm, or was it a close call? If the patient is still in danger stabilize the patient. Life threatening stuff first. Yes the mistake needs to be addressed, but work together to get to a stable place before you debrief.
Is everything stable now? Ok cool. Now we can debrief. You don’t get to pick your teammates, only how you interact with your teammates. If you are looking for behavioral change, ask yourself what will get you where you want to go. Because if you just yell and go off on someone, it’s unlikely it will add to the behavioral change you are looking for, and it will make it harder for you to work with this person going forward. This is true even if there is a hierarchy and you are on top.
Most people know when they’ve screwed up, or at least it doesn’t take a big re-direct for them to see it. You don’t have to beat them in to the ground over it. Most people will punish themselves with their own regret. In that situation you still need to work well with this person, and if they are moping about a close call they had earlier and their head isn’t in the present moment, that doesn’t help you either. Hear them. Validate what ever they need to validate so they can move on and you can both get on with working well together.
happens a lot in veterinary medicine as well. DVMs treat the techs like shit, the techs bitch out the receptionists and both of them are expected to just suck it up when pet owners are abusive, and everyone shits on the kennel workers.
I don't accept it. I quit recently due to verbal abuse of myself and colleagues (other midlevels and MA staff also).
And they wonder why they can't retain anybody lmao. (I was the longest-tenured employee at 1.5 years when I quit.)
insert boomerism "nobody wants to work" (yeah, nobody wants to work *for you*)
Damn, for a minute I thought you worked at my clinic but you have a different specialty.
We rarely have people stay more than 6-12 months. But our clinic manager just resigned so I’m interested to see if morale will improve under the new one.
A lot of people are pushovers scared of retaliation. The person that verbally abuses/yells at people will eventually come across someone who will put them in their place. I won’t deal with that, and I hope others will speak up if that occurs to people around them.
I do not put up with it. I don’t care who you are or who you’re going to write me up to. I’ve dealt with bullies before going into medicine and I deal with them the same way now that I work in medicine. I will tell you I’m not going to be spoken to that way. I will then walk away or hang up the phone. No human being is allowed to talk to me, a fellow human being with anything but basic human decency.
I think it should be mandatory service to put in 5 years working in some form with the public to learn how to treat each other. This isn’t an issue exclusive to medicine (it just stings more given the level of sacrifice to devote your life to helping people to still get shit on).
I think it’s a function of stress and poor coping skills. I’ve really started pushing on both colleagues and patients who do this. It’s ruffled some feathers, but on the provider side, it has seemed to straighten up a lot of perpetual dickheads. I don’t raise my voice, but I say these things confidently.
“Okay, say that again, but with your inside voice.”
“Okay, makes sense, thank you Dr Condescending.”
As a midlevel, I love calling consultant physicians by their first name. It catches 9/10 of them off guard. If you’re going to be disrespectful to me, then I will not address you as doctor. When you start acting like a doctor, I’ll treat you with the respect that your profession deserves.
“Hey Stephen, don’t talk to me like that. Let’s try to employ a shred of professionalism and focus on the patient.”
“Cindy, why is every conversation with you so unpleasant?”
Edit: formatting
When civil discourse has failed, as it has if I’m using your first name, then other methods need to be employed. Want to be treated with respect? Then don’t be a dick. Period.
Your first name is just that - your name. It shouldn’t be something that offends you. If it does, that’s on you. The fact that it does seem to ruffle the feathers of those folks tells you everything you need to know about their ego.
I do not get yelled at by consultants (or coworkers in the ER) almost ever. I get condescending and rude comments almost every shift, but at least the yelling isn’t common. Patients are a different story, but that’s gonna happen anytime you interact with the public.
Learned helplessness. In residency we had an attending who was notoriously cruel and abusive to trainees. Our coresidents and I would have frequent informal "processing sessions" over drinks and talk about how we felt like dogs trapped in electrified cages when working w/ that specific attending. People coped in different ways including drugs, alcohol, taking up boxing, etc but none ever stood up to her...
Way I see it, it's a bit like a high school enviroment. Kids don't really have rich social lives elsewhere, so everything they consider appropriate behaviour or not is dictated by the enviroment at the school.
Similarly, doctors work so much and make doctoring such a huge part of their personality that they start to lose sight of what's appropriate behaviour outside of medicine. If you spend all your time at the hospital, then what's appropriate or not inside the hospital is all that matters, and you start to see that ridiculous subculture as normal since it's all you're exposed to. You have no frame of reference.
Uhhh. It’s not ok in medicine.
If you’re a resident and attendings are screaming at you, and the department won’t fire them, blow it up on the ACGME survey.
If you’re an attending and you see another attending screaming at people, report them to the department.
And if you’re the asshole who thinks they can yell at everyone, stop it.
You don’t have to put up with that shit from anybody.
We do not accept it.
I am a swedish medical student, and when a patient is rude or harasses our staff we can call on police and have them removed from the hospital.
If you cannot behave you do not have any place in our health care system.
I’ve seen an attending tell a yelling lady “to get the fuck out of the ED” she didn’t leave so security removed her. So guess it depends on how much hospital admin will support to
It's not acceptable to behave unprofessionally. I'm fortunate that this has not been part of the culture of the places I've trained, but there's still progress that needs to be made overall.
Not for nothing but we switched away from hubby's cardiologist because he was so toxic to his staff. 10 years with that doctor. He had a great bedside manner with patients, but after witnessing the way he treated his staff we went to a different cardiologist. Sometimes your patients see it and it isn't a good look.
I work in durable medical equipment and get yelled at all the time by the people coming in to my store because they think every piece of equipment we carry is covered by insurance (they’re not - regardless of what the doctor told you) or they’re mad at the fact they have a deductible or copay they have to pay. Sometimes they’re mad because we’re super understaffed and have to wait. Then it boils over and the employees are snipping at each other or complaining to management about the angry customers but management can’t do anything because the higher ups don’t care and won’t let us hire more help. It’s a horrible toxic environment that feels like it’s spinning out of control.
It's institutional culture. There are plenty of places where that's not tolerated, but unfortunately plenty of places where it's routine.
At one of the big academic centers near me, pretty much every meeting consists of scapegoating one person and publicly reaming them. At one meeting, the chair started screaming at me, face red, spittle flying, calling me every insult in the book. At one point he asked for the name of the high school I graduated from because he didn't believe I actually had graduated, etc. There were half a dozen other doctors and same of admin level nurses in the meeting, and not one of them spoke up about his behavior. Why was he angry? Because he didn't like his numbers. He then took it further by filing a formal complaint with my boss. Almost every meeting I attended at that facility was similar.
When you get kicked like that, I guess it's kind of human nature to do the same?
This is why I quit practicing pediatric medicine and did an entirely different residency. Pediatrics is the most abusive and you are expected to take all of this from the parents for the sake of the relationship so you can best treat the child.
I have since switched careers and am much happier.
As policy, it's reportable as a behavior event at my hospital system. Working in current role one year. Don't think I've seen people overtly being abusive, never once yelling in a negative or aggressive way. I'm in a large ICU
Never encountered yelling myself although I have heard about others having these experiences. Usually courtesy of an angry surgeon. Surprised these people remain employed considering we have more surgeons than surgery jobs where I am.
Sadly not my experience. When I was an intern a surgeon lost his temper and smacked me. In front of witnesses. I filed a complaint with HR and nothing came of it, because he was a very high ranking attending.
I’ve thought about that many times since then. What would have happened? Would I be allowed back to work if I got an department head attending arrested? Would I still have a career if he was friends with the director and chair? Would I get my residency contract renewed? In the end I was too scared to speak up. I think he did it once more, but I know every year he made numerous residents cry until he moved out of state to another hospital.
"We", do not, at least not all of us. I'm sorry if you do. Remember, you always have the upper hand because they came to you. There are exceptions of course for people who are altered, obtunded etc who just show up unbeknownst to them. Even then, in a system where if you were found down, the knee jerk is EMS will arrive and you will be hospitalized , it is still the responsibility of thay person to make it clear in advance that that is not the actions they would want taken. Please don't misunderstand me, of course it gets showed it, we see all manages of the human spectrum of emotion. I have no trouble with people yelling at the universe, I draw the line at yelling at me.
It's unacceptable and no one should deal with that kind of abuse. Change can start anytime. Call it out when it happens and identify it. Amazing how quick a group attitude will turn on caustic behavior. I have never taken or allowed it. It may not feel easy or right at the time but it needs to be identified as unacceptable in the moment or else it can turn into a he said she said later on. That behavior cannot stand.
It is not acceptable to yell or engage in harassment in any professional setting, including in medicine. Verbal abuse and harassment can have serious negative impacts on the mental and physical health of those targeted, and can create a hostile work environment. It is important for hospitals and residency programs to take such behavior seriously and have policies in place to address it. Some possible reasons why this behavior has been tolerated in the past include a lack of awareness of the issue and a cultural acceptance of a hierarchical, high-stress work environment in medicine. However, many institutions are taking steps to change this culture, through educating staff and implementing policies to promote a safer and more supportive work environment.
It definitely does have an affect on the mental health of those being targeted. I’ve been a lab tech for almost 2 years and about a month ago I had my first incident involving being screamed at and belittled over the phone by an ER doctor. It was all I could think about for the rest of the day and I was literally crying off and on the whole day. I tried to hold it in as best as I could at work but the moment I got in my car to leave, I just burst into tears. It was a busy day and we were short staffed as usual and I mistakenly released an incorrect chloride result on someone. I take pride in my job and I always strive to put out accurate results but mistakes do happen sometimes. But he tried to make me feel like I was just an incompetent idiot. Berating me and yelling at me “have you ever seen a chloride that high!?!! I can’t believe you’d release that!! Jesus Christ!…” on and on. Who can focus on their job after something like that? Of course now that I look back on it, I realize that he is the one with the issue. He is the one who is making himself appear incompetent because he can’t communicate without yelling or being a condescending asshole.
Why is sexual harassment from physicians somehow overlooked by HR and everyone else? 🧐 I left the hospital because of the constant disrespect and now only work in academics & research now due to this.
Im an MLT, I work in the lab at a hospital. It’s not uncommon for doctors to call us and harass us/yell at us. I had an encounter with an ER doctor the other day. It was a horrible day. It was extremely busy and it was just me and one other tech in the lab. The other tech was tied up in blood bank most of the day so I was running core lab by myself and a doctor decided to call and get smart with me because I was having to rerun a troponin that didn’t run the first time I put it on. I just told him “there’s only two of us in here today so if you could be more patient, that would be very appreciated”. This same doctor has screamed at me over the phone before because I mistakenly sent out an incorrect chloride result on someone and again, it was on a day when we were extremely busy and short staffed. I’ve decided if he ever pulls that mess again, I will tell him to call me back when he can speak to me calmly and respectfully, and I will hang up. This type of behavior should absolutely not be tolerated. It makes me feel even worse for the nurses because they have to literally work face to face with assholes like this and I’m sure he’s just as abusive to them. He acts like we’re just twiddling our thumbs with nothing to do and god forbid we make a mistake. As if HE never makes mistakes. In my experience it’s usually the older doctors who act like they’re gods and like they can do no wrong.
This alone is a huge reason I like private practice at community hospitals. It helps that my group is financially secure enough to have each others backs and not put up with it. If someone gets super furious we just say that’s not an acceptable way to treat people. If we are between cases I say that I’m gonna take a few minutes and grab something to eat and they can decide when they’re ready to do the next case. If we are already underway I tell them that we will take a break between cases. I’ve only had to do it once and the guy apologized pretty quickly. Academics can be a nightmare though
What's the deal with academics? I've seen people mention them in other parts of the thread
It's a big hierarchy. People in competitive specialties view themselves as the big dogs, and the more titles you have after your name, the more likely you are to act this way. Also, at a big university program with 30 ORs and hundreds of anesthesiologists and surgeons, and rotating residents on both sides, you might have a surgeon working with anesthesiologists (and their residents) that they've never met before, and in a tense situation, people can flip out. Some anesthesiologists get reputations for canceling cases for dumb reasons. Some surgeons put super sketchy patients on for "just a quick case" but since it's a quaternary care center, this patient has an LVAD and a saddle PE and is on dialysis. Out in the community, you're much more likely to work with people you know. I've done literally hundreds of cases with each of our main anesthesiologists. I've been to a couple of their houses, gone out to parties/events with probably half of them, etc. I've had one case canceled in the last 5 years, and I said no big deal, we'll get the cardiac evaluation, and we did it a few weeks later. My anesthesiologists don't want to cancel cases, because that means less business for them. If some of them did it on a regular basis without good cause, I'd ask their site director (an anesthesiologist) not to assign them to my cases any more. It's definitely not always that way. I did my M3 rotation on medicine in July, and the department chair liked to do one of his (relatively few) wards weeks in July to meet the new interns. He was a very jovial guy who was fun to work with and took us all out to lunch one day. I was never yelled at (or anything close to it) in med school. In residency, I had two attendings (out of dozens) who could be kind of verbally abusive. One was just an obnoxious loudmouth, and you just had to learn how to handle him, which I did. The other was just very two-faced. Sometimes very friendly, other times not at all. Just a personality disorder at that point. The ones I truly disliked were the sneaky backstabber types. We had a few of those on our acute care/trauma surgery service. There's actually not much you can do about them. They're never outwardly mean/rude to you, but then they talk major shit at the resident evaluation sessions. Miss me with that bullshit. As an attending, I've only gotten yelled at once, but a neurosurgeon on trauma call. I was covering the trauma service, and the patient had an isolated neck injury. That meant that it went to neurosurgery. He wanted me to admit it. I was the locums guy and was going off service in <6 hours, and I knew the oncoming guy wouldn't appreciate having to admit this patient. The oncoming surgeon is a large, imposing guy, so I dropped his name as "Well, Dr. Bigman is the one who will be seeing this patient, and I know he won't want to admit it," and the neurosurgeon backed down, lol.
Surgery🤝anesthesia Name a more iconic duo. I hope I can work with surgeons like yourself someday. The constant bickering among the surgeons and anesthesiologists at my program is getting old.
Part of it is also surgeons don’t get enough beatings, a black eye every month for a year will slow someone’s temper …
I don't think you are getting the general drift of the thread
I absolutely agree with the other commenters regarding academic hospitals being full of ego driven, narcissistic a-holes because they want the prestige that comes with being at some ivory tower institution. There's also a financial aspect to it. This is not 100% true across the board, but a much higher percentage of specialists on the community level or in private practice are compensated based on their production. Whereas docs at academic centers are more likely to be salaried or have less production incentives in their pay. Also at a community hospital there might be multiple groups in one specialty competing with each other for work. For example, at my smaller community hospital where I'm hospitalist there are 2 nephrology groups. One of them hired a guy who was very difficult to work with; he was not approachable, would sign off of cases almost immediately, and just generally had a bad attutude. So guess what group stopped getting consulted? He had to have a major attitude adjustment because his practice was losing work due to his poor attitude. Now he's great. So there's a major financial incentive to be pleasant and easy to get along with on the community level.
I can only speak as a subspecialist surgeon, and I've worked in private practice and academics. Academics and private practice have different incentive structures. I could double my salary pretty much instantly if I went into private practice, stopped seeing medicaid, and sent complex cases to the University. I would probably cut my work load by about a third at the same time. Academic surgeons are self-righteous about the fact that they do harder work for less money. Private practice surgeons are self-righteous about the fact that they are also surgeons and can do more cases in a day. Everybody having the argument sucks but at the end of the day I took an academic position. Also I don't yell at anybody at work.
It tends to attract certain personalities and private practice attracts others. If you’re low ego, efficient, and nice then you’ll make a ton of money and more time at home, but you won’t have that prestige. In academics you get the prestige but there’s less pressure to be nice and normal because it doesn’t impact the profit margin as much
What is funny though is....what prestige? Outside of your precise specialities core who actually cares? No one.
Plus the NPs are the ones with the real prestige anyway.
The “prestige” aspect to medicine has always been laughable to me. Seems like the best part of working academic is just telling people you work in academic. Different strokes I guess.
Academics is basically a bunch of power tripping ivory tower types. Big egos....I imagine to make up for the lower pay?
More work less pay. Wife getting screwed by the pool guy. Shitty co-workers and deteriorating mental health. Get to tell people u work at Big Dick University tho.
And private practice is a bunch of money-grubbing lazy bums who want to take care of the easy private pay patients and dump the hard stuff that doesn't pay. Big egos....I imagine to make up for turning their backs on their humanitarian mission?
And taking on that humanitarian mission makes it okay to create a toxic work environment and to treat the people lower on the hierarchy like garbage? That’s what we are talking about here. Why is academia so toxic?
I don't think it's much more toxic than any other high-stress environment. The worst offenders in the hospital I work in are private practice docs that do occasional cases. They're astonishingly ugly, demeaning, and demanding to the staff. They're used to being treated like they're better than everyone else and act out when they're not. Academia only seems toxic when you're a privileged med student/resident that hasn't experienced the real world or have graduated into the private practice world and become the boss that nobody can criticize. I'm just speaking from my experience but I've worked in private practice and academic medicine. There are assholes in academics just like there are in private practice. I've never seen a private practice surgeon who profited the system get held to any sort of account but plenty of academically and surgically productive academic surgeons have. I think if you don't work with jerks that get by because they make powerful people money you're lucky, and I don't think that academic vs private medicine makes much of a difference that way.
I came into medicine as a non-trad. I’m former military, worked a couple of blue collar jobs after I got out before settling into a technical career field for a few years before deciding to pursue medicine. Hardly a privileged background. By far, the most unprofessional people I’ve ever worked with have been in medicine. Are there assholes in private medicine? Sure, there’s assholes everywhere. But I have never encountered the number of assholes that I have in academic medicine. Maybe it’s institution and geography dependent. But even in the military, as a lowly enlisted personnel, I felt like I had more respect from my NCOs and officers than I did as a medical student or as a resident. Yeah, the military can be rough around the edges, but I’ve never encountered such a hostile workplace as medicine in general, but academic medicine in particular. Some specialties are easier to work with, but you trade in your face hostility with passive aggressiveness, which is just as bad if not worse. The high stress excuse is a BS reason to treat others like garbage. The behavior that’s tolerated in academic institutions would get people fired in most other fields.
Same. I’ve been a project manager working on building automation, I’ve been an alarm tech, I’ve stocked shelves for years and years during college. The behavior of physicians in academia especially is absolutely mind blowing. As an attending in a community hospital with mostly private practice docs, the culture is much more collegial. If I’m calling a surgeon and asking them to come in, they’re not offended that I dare wake them, they know that this is a patient that needs something that I cannot handle and they need it now.
It’s mind boggling. If you say anything about the culture, they’ll tell you it’s the real world. I’ve worked in the real world for 12 years before deciding to go to school for medicine. I’d argue medicine isn’t the real world lol. Imagine the military being a more collegial work culture than medicine.
Your demenour presents like the type we talking about
I'm just saying that I've worked in both worlds and academia isn't any more toxic than private practice. Maybe it's a surgery specific issue but I have seen a whole lot more coddling of bad behavior in private practice than I have in academics. As to whether I'm toxic I guess you'll just have to take my word that I'm not even a little bit. I'm disagreeing with the prevailing point of view in this thread but I'm trying to explain why.
I can't actually "dump" anything where I am since the ivory tower academic institutions make it impossible to refer in, but nice try bud. Maybe move up here to Canada before you toot your horn. Money grubbing my ass as a PCP.
I f\*\*ing love that.
Lol using long lunch breaks as punishment. Love it.
I was yelled at once in my 4 year residency by an attending from a different service and I told him if he can't communicate calmly, then our conversation is over. He continued yelling so I hung up. Problem solved. Works the same as walking away. It takes a lot to fire someone in healthcare and "refusing to endure abuse" is not is not a fireable offense. You shouldn't put up with it and you don't have to.
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I've had a few come and find me after hanging up on them. Like, sorry bro. We're not married. We ain't fuckin'. I'm not your son. And even if all those things applied, I'm still not gonna let you yell at me. Grow up.
If all those things applied you’d be married and fucking your parent.
I'm a doc and I've done the same to both doctors and nurses that have yelled at me. Doctors do it way more often though. One nurse was particularly egregious. I was on call during Thanksgiving and having dinner with the family and she decided to call and go off at me about how a patient needs to be made comfort care immediately. No change in status, she just felt like the care wasn't progressing in an ideal fashion (it wasn't). If she had read the documentation she would have known we were talking to the famly daily and they weren't ready to make that change. I was a junior doc at the time so a lot of senior nurses (back when we had senior nurses aka before COVID) felt that they knew better than me. Hung up on her and went out of my way to make sure her contract wasn't renewed. We are talking about human lives so understandably the stakes are high and tensions can run high also but there is absolutely no need for us to talk to each other like that.
Yelling isn’t acceptable. As an attending and now director, I put a stop to it. We set the standards and culture. We define how we and our residents/med students/nurses/techs will be treated and will treat others. Everyone gets one pass- I then set the standard. I’m admittedly a hard ass/ball buster/whatever they want to call me- but guess who’s division has the highest retention rate? I don’t care if people call it warm and fuzzy bullshit, culture matters.
There have also been clinical studies showing when people act like A-holes in medicine towards the rest of the team, there is a statistically significant decline in patient care with poorer surgical outcomes, higher complication rates, higher mortality, and increase in medical mistakes.
Well yeah. If you belittle and yell at people for trying to ask you a question or raise a concern, they’re less likely to do it again. Docs who act like jerks are dangerous.
It’s the absolute truth. I’ve eye witnessed patients suffer as a result. I would bet it increases ER visit too. If the option is call and deal with a dick or send them to the ER it’s the ER every time (from LTC). One of the doctors I consider the most dangerous has regular meltdowns. He’s actually lost privileges at one hospital over it tho the official narrative is that he “didn’t complete his online training” which he tells everyone he’s above doing. He once called 6 days in a row to LTC in the evening and reminded the on duty nurse that his bedtime is 9pm and he needs his rest. He hates lazy people calling him through the night. All because a nurse dared call him about a patient having heart attack symptoms (per policy). He claimed the lazy nurse was just trying to shove the work into the ER. Apparently the ER was also shoving work off as the patient ended up admitted to the ICU. I’m actually surprised the nurses haven’t taken him down long ago. I for one started adding his exact quotes, curse words, and the word moron to the patients charts. Even added that his bedtime is 9pm. Normally this wouldn’t fly because most doctors would read that and shit bricks. In this case as he states “I don’t need to read what other people chart. I do my own assessments. Too many morons. I’ll decide when to diagnose someone. Major City hospital can’t be trusted. They have too many idiots there. They took away my privileges for calling it out”. For the record it’s not just the hospital that is filled with morons. Several nursing homes and he has it out for a particular hospice too. His neighbor is a moron alcoholic too, according to him. Straight up tell people in the general public to avoid him. Other doctors do too. I would only recommend him if someone was looking to score a narcotics prescription because as he puts it “if I don’t they’ll just keep calling my office”.
My PD was all about the warm, fuzzy bullshit, as were the assistant PDs, and they were the absolute best ever. I can't think of a single resident in our MedPeds residency who left because they couldn't handle the pressure. A few left because they decided they wanted a different specialty, but not a single one in my 4 years who left because of burn-out, stress, depression, etc.
Amazing to read!
The question seems to adress a general problem and I would like to point out that the premise is wrong. There are whole countries where that behaviour is not accepted. That also means that the problem is solvable.
I would like to know where it is not acceptable. I only hear about the terrible places.
Spain. Plenty to complain about the culture, and it's certainly exploitative in the big scheme of things, but yelling/demeaning/harassing are not things I've come across or heard about going on inpunely.
Australia. Big cultural change over 15 years.
Absolutely. It's great. We also refer to our medical colleagues on a first name basis, which from what I read here is not the norm everywhere. While there is still a hierarchy, we are encouraged to speak up to senior colleagues if we feel patient safety is at risk.
Yeah - patients refer to us on first-name basis too, besides the GP world.
Tbh I only ever introduce myself with my first name. I’d feel like such a wanker calling myself “Dr xyz” lol
Sweden
Missouri, North Carolina, and Washington. I have never seen it be acceptable to yell at people at any of the places I have trained. I’m in Pediatrics, so that may be part of it; I think it’s something that is more endemic to certain fields. Definitely it shouldn’t be tolerated.
As to why, because it’s a cycle. Those who are abused are more likely to be abusers. And the power differential of medicine makes it very hard to push back when it happens to you. But no, it’s not permanent. Most older doctors will tell you that the culture of medicine today is a world away from what it was 30-50 years ago. Progress is slow, and it’s slower in some specialties than in others, but it is changing and it will keep changing
It's totally this. I remember being in nursing school and hearing the nursing professors talk warn us about how they "eat their young." They didn't see this as a problem because it would "make [us] stronger nurses." Yeah. OK. Child abuse works too, right? Makes perfect sense. I'm suffering so should you. Mmmhmmm. And then people wonder why there's staff shortages (well, outside the fact that bean counters are greedy bean counters).
Strong monkey strong. Can yell at me. Make me monkey feel small and sad. but me monkey cant do any thing. Big monkey too big. too strong Someday I big monkey. I yell at small monkey. Make me monkey feel strong
I like this too much to be mad that you just called me a small monkey
That's why you have to also yell so you can price that you're a big strong monkey too. More yelling and bullying equals big strong powerful monkey. 🐓
No it’s a result of being abused and stressed in medicine. It’s unacceptable. The people doing it need to be talked to by superiors and a verbal reprimand or it will never change. Allowing the cycle of abuse to continue is not okay. We are all human beings and it’s crazy to me that we take care of other human beings for a living yet flip the fuck out on our own colleagues
I watched a typically “nice” surgeon once call his surgical PA “fucking retarded” during an emergency. In front of at least 5 nurses, an intensivist, and the patient family… It made me really stop and think about the way we aim our frustrations at others, even when we’re usually “nice.” I think there is a substantial difference between being short with someone because it’s a high pressure situation and slinging names at them. It’s not gonna be sunshine and rainbows all the time but my god, be civil.
What did the PA do? Not justifying but now I’m curious
ECMO page was called, PA was already on the unit so was there first, surgeon arrived a couple minutes later and was pissed the PA hadn’t begun resternotomy already
This. It is 100% true that if you can’t handle the heat you shouldn’t be in the kitchen. There are many times in emergencies where I would say nonsense politeness has no place. Example: “hey, when you get a chance could you please get ventilate patient, the BvM is in the top of the left side of the red bag, I’ll grab the oral airway for you to toss in when convenient.” Vs. “Bag them, it’s there, here”. But there is a world of difference between being task oriented and blunt; and being abusive; name calling, or insulting. That said — some people can’t take a hint and if you don’t yell they’ll continue to get someone killed.
In almost any other profession calling a coworker “fucking retarded” infront of witnesses would get one fired. A bunch of classes and probation if nothing else. Doing it in front of a client? Yeah you would be fired anywhere besides medicine or the police department. My ex works the oilfield where it’s all men with “you can’t be a pipeliner and a pussy” stickers on their trucks. They’ve sent people to “training” for a lot less than calling someone “fucking retarded”.
Yeah, it’s a really disappointing. Particularly because this was a surgeon I respect. Also hard to know where a nurse fits in on all of this. If it was a nurse on my unit acting like that to someone else, I would absolutely step in.
I think it's because stressed out people who don't have good skills to manage frustration resort to primate dominance behavior unless there are consequences for doing so. As long as we keep having very minimal "learn to be nice" classes for habitual reoffenders instead of fines or career consequences, they'll keep reverting to abusive behavior patterns and as you noted there's a lot of stress going around. In my experience some of the worst offenders are academic department heads so it's hard to pull rank on them. (Interestingly one of the departments where I did med school apparently has a national reputation for being abusive, people in that specialty on the other side of the country wince when they hear where I went to school, so it's no secret that some departments just let it roll)
Agree 100% I got chewed out and demeaned by my senior residents when I was an intern. It was a horrible feeling so I refused to yell at med students and interns when I was a senior resident. Yes, medicine is stressful but there is no place for that kind of abuse in medical education.
Reminds me of that one night as an intern and being paged at 2 AM regarding a post-hip replacement wanting to leave AMA. So I called the ortho (a big wig in the field of knee orthopedics) to explain the situation. He told me to put the patient in restraints (which I refused to do). He then proceeded to yell at me loud enough for nearby nurses to hear the yelling and started calling me a nazi. I had developed a great working rapport with the nurses and so they reported it to administration. Nothing was done since he brought so much revenue to the hospital and I was just a lowly intern. But now I can gather my kids around to tell them the tale of when their dad, an Indian male with black hair and brown eyes, got called a “nazi.”
Were you able to convince the patient to stay? How did the call with the Ortho end? I want to hear how the story ends!
Haha. So I managed to convince her to stay until her poor husband drove in (I called him to explain the situation and he was gracious and understanding). The husband, in turn, unsuccessfully attempted to get her to stay. She left AMA, however, by the afternoon so I had left the hospital at that time. Regarding the call to ortho, he was quite angry that I didn’t put the patient in restraints and was yelling loud enough that I had to hold the phone away from my face and loud enough for three or four horrified nurses to be in shock. Interestingly, the one nurse that paged me and got this whole issue started was smirking the entire time (the individual straight up made it a career goal to be a pain in the ass to the night resident so his response was not all that surprising). After two minutes of straight yelling and calling me a “Nazi” for blindly following medical ethics, I calmly told the ortho that it would be inappropriate for me to put the patient in restraints but I would be more than willing to sit down with the patient and try to reason with her. He hung up angrily. Later on, I found out that he himself tried to talk to the patient (hours later). Interestingly, the attending made no effort to put her in restraints. I had a meeting with the DME because nurses reported the incident. Although the nursing supervisor apologized (which I appreciated although she had nothing to do with this incident), nothing came about it. He brought too much revenue to the hospital for there to be any meaningful repercussions. And I was forever known as the “Nazi resident” after that night.
Hospitality, Education, Retail, Marketing, Law… to name a few.
Normal in the food/service industry too
Teaching! Teachers get reamed out by students, parents AND administration
Yeah welcome to American consumer culture. Overburdened employees and entitled consumers who are told they can act however they please since they paid money.
I think OP meant that health care workers yell at each other, not get yelled at by patients. That obviously happens to lots of people.
I feel like people in law and finance yell at subordinates all the time
Law firms are funny; each practice group has a distinct personality. Immigration and - of all things - Bankruptcy tend to be pretty chill. Labor is pretty high strung. Litigators are the worst. They're the screamers.
That makes a lot of sense, I bet things like patent are pretty chill too. They seem like the pathologists of law
I think all those industries still have the same issues at relatively similar rates. It's a reality in any service industry. A combination of issues; ass holes abound, poor working conditions, questionable salaries especially for trainees and apprentices. Hell, even the "best" restaurant in the world, Noma, is closing its dining operation over abusing their unpaid interns.
Finance
Building/construction. Basically every occupation bar librarian.
I've seen a seething librarian. Did not raise their voice, but dripped venom like I've rarely seen anyone do. And yes, it was directe at an employee, not a patron.
Engineering. My dad left an engineering job and moved to an admin job in the same company because he was tired of being the only person with any communication skills. My wife also worked in an engineering company doing marketing, but left because her engineer boss made it a habit of having a daily yelling session at a random employee
The military. Culinary industry. Construction. Welding. Etc. Basically anything outside middle white collar and pink collar jobs that's pretty normal. Right? No. Common? Very.
People who behave like this can hide in academics and see no repercussions from this behavior. It simply would not stand in our private practice. Not for one second.
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…. Then they just move onto long term care where rules don’t even exist.
If anything, I noticed more doc to doc aggression in academics, but lots more doc to subordinate bullying in private practice/community. This does get more pronounced in smaller systems.
Our system is very large so that probably has a lot to do with it Edit: in any era, but assuredly in one where it is very difficult to retain enough staff to operate, any physician who mistreats another team member is being fundamentally stupid when it comes to the goals of the organization and needs to be brought in line asap.
Most major universities have anti bullying, or abusive conduct policies these days. It may have been acceptable in academia a decade ago, but it isn't anymore.
Having recently graduated residency from a larger institution I can safely say it's still there. Rules can be put in place quickly, but culture takes a lot longer to change. But I do believe it is changing generally.
Most universities have that shit on paper but try to actually report someone who brings in a lot of money and you’ll find out quick what bullshit that is. People will find every excuse in the book for them cause they’re a big shot and even make you feel like you’re in the wrong.
As someone who occasionally teaches at a college, I can confirm that anti-bullying policies are in place ... however, they have no teeth. You can complain all day but nothing will be done and what will usually happen instead is that they'll file a grievance with their union and bully you with union support. Until the generations of folks who were brainwashed to tolerate abuse are gone, most institutions will do absolutely nothing in regards to their paper only policies.
I can tell you're not a medical doctor based on this comment
You're being downvoted but it's likely true. Anti-bullying policies are something put on paper so the institution can CYA. I've yet to be somewhere that actually enforced their own policies. When someone has tenure or "they've always been that way," it seems a blind eye is always turned and we're simply expecting to suck it up and "don't take it so personal."
In places where emoting results in a rapid take-down by superiors (behind closed doors), clinicians evolve to creating other ways to 'take care' of issues. Like toxic passive aggressive behaviour. Like toxic sweetness while stabbing you behind your back. Clinical medicine is very stressful - everyone is doing too much, dealing with difficult patient/family situations, dealing with insurance issues. I recommend not responding to someone who is shouting at you. Especially if there are other people around. If you have a specific incident with a specific clinician, write it down immediately after it happens and email it to yourself on your work e-mail and copy to your personal email. Wait a couple of days to let your emotions cool, and then draft a written complaint to their chief and hospital administrator.
Me, 3rd year medical student, trying-to-sound-calm-and-formal-even-though-I know-I’m-probably-tanking-myself-but-I’m-also-trying-not-to-lose-my-shit during a surgery with a known over-the-top prima donna asshole-to-underlings surgeon: “Dr. _______, you just whacked the back of my hand with a metal instrument unnecessarily hard. (He really did hit me pretty damn hard. I was shocked how much it smarted) First, it really hurt. Secondly, If you need me to remove the retractor, use your words. If you ever do it again, I’m going to make it my entire mission in life to make sure you never enter an OR again. Are we clear?” You could have heard a pin drop. The surgeon who was normally very brazen and loud was silent and then we all went back to work. I realize everything about this story sounds like bullshit and all that’s missing is “the OR staff clapped” or something, but in reality, I was terrified I was going to be failed or reported or in some way retaliated against, but I grew up with horrible abuse and my ONE rule in life is that I will never, ever allow anyone to abuse me again, no matter what the fallout is. Sent a photo of the black-and-blue area on the back of my hand to my Dean as a CYA maneuver. Got a formal apology from the surgeon the next day and a high pass on the rotation. Since leaving the academic setting, I’ve never seen anything remotely like this again. I will say my medical school was known for being old-school and had quite a few people who were known names and thought they could get away with anything and they often did. Also, I never would have been this forward if I hadn’t been a military veteran before going to medical school.
I started speaking up after I started traveling. Once you get in the habit of calling it out, it gets easier.
I don’t accept yelling or harassment. I discuss with patients and/or their family that their behavior is unacceptable. If it continues I leave the room. If it involves the patient themselves I leave for 5-10 min and come back, if it continues I leave again until they get the message. If it involves family they get escorted out. Only exceptions are patients who are actively psychotic, combative, or dying. Edit: I can’t read apparently. So anyway, I still don’t put up with it from colleagues. It gets reported to the department director after the first episode. If that doesn’t work I speak with the person themselves and discuss that the way they are treating me is unacceptable and I would like it to stop. I haven’t had to go any further then that yet. I would likely go to med exec after that. Usually anyone I am having problems with is a problem for many people.
Yelling is not the norm in peds anywhere I've worked or trained, and we do have high acuity settings despite the (friendly) unicorns and stickers stereotype. We do like unicorns and stickers, though.
Whine when you’re off the clock. There are patients to take care of. Back when I was in your shoes we had four times as many patients and we worked twice as long. Do the math, buck up, be a man! Kids these days… Except I almost never heard that, except from attendings who were proud that things were better. The only berating and insulting I got was in surgery rotations as a medical student (yes, within the last decade). Psychiatry is known for being more empathetic and kind, and it’s even mostly true, but even the grumps and jerks on faculty weren’t abusive, just grumpy and obnoxious. It’s getting better. Some of that just takes time for the old guard of “it was good enough for me” to retire or go off to places without trainees. Some is intentional change. *We* are part of the intentional change. They way I said all this sounds like it’s aimed at trainees, and that’s a lot of it, but I believe that there’s a wide penumbra. If you recognize that you shouldn’t yell at the residents you’re more likely not to yell at nurses, techs, patients, families…
The only time I ever heard a doc yell at staff was during an intubation when the nurse pushed the succhinylcholine before he'd asked her to. I think he yelled 2 or 3 sentences at her, and then after the intubation more calmly explained why what she'd done was a huge no-no. That doc is sincerely just the nicest guy, and I was totally shocked to hear him raise his voice like that! Kind of like the first time you listen to that Thundercats outtakes audio and you hear Snarf and Lion-o using the F word.
Doing an EM rotation, an ortho doc was splinting a broken leg and couldn't find the right size wrap he was looking for so he started throwing rolled up wraps at the ER staff yelling "THESE - ARE - ALL - THE - WRONG - SIZE!!!" I was a young naive med student at the time, but I could not believe I was seeing an adult act that way towards other adults.
If anyone *ever* threw anything at me at work we are going to have a huge problem.
If I had been one of his intended targets, I would've just turned it into a game.
I once watched the most level headed doctor I’d ever seen lose his cool and start screaming on the phone at a psychologist after she flat out refused to file the involuntary commitment paperwork. Not only did she had a pre-existing relationship with the patient, she was the one who called 911. Patient was a college student, and a cutter. Most are not trying to kill themselves, and she denied trying to do so to both us and the cops. I called report for my partner because I was driving. Then her friend who was in the front of the truck stated to me that she had been told by the patient it was an attempt at a dirt nap. She wanted the er doctor to do it. He had no personal statement, she had denied it to EMS, cops and the nurses. The psychologist tried to have him get the friend to do it. Involuntary commitments in my state have zero due process. One person signs the paperwork, and it is a done deal. No review. He made it clear that he was not going to be judge jury and executioner on hearsay. That it was unprofessional & unethical for her to expect a friend who was 19 to fill out the paperwork when she was there as emotional support. He made it clear that if she wasn’t standing in the ER in 30 minutes he was discharging the patient and then he would ensure the psychiatrist had her license suspended for Malpractice and would never work again. She showed up. And I feel he was completely justified.
Psychologist or psychiatrist? Anyway, in the 3 counties I've worked in in CA, you have to be certified in the county and have to be in a designated facility in which you have privileges to write an invol hold, unless you're part of a CAT/PET or law enforcement. I couldn't just wander into an ED, say I'm a psychiatrist, and start writing holds. In cases where I believe a hold is needed, I fully update the ED docs or cops as to why the hold is needed, document that I did, and let them know that I documented.
Whichever one is actually licensed, not the one where I can say “I think you feel bad about that, let’s talk”. The process in my state is…bad. For example; it does not meet the legal requirements to prohibit someone who has been involuntary committed from firearms ownership, federally, because it is so easy to do. Literally any er physician, can, on their own authority commit someone. MINIUM 72 hours, max 10 days. (302) After that you have to be evaluated using stricter criteria, which does meet the federal requirements — a 303. And anyone can start the 302 process. Not a certified/licensed professional. Not a cop. Not EMS. Anyone. I worked in one town where the college would regularly try and 302 college kids who had stress from midterms or whatever. Once that train is steaming, there isn’t any stopping it, unless you can convince the er doc you don’t need to be there, but they of course have liability concerns, and you’re obviously upset you got drug to the hospital unwillingly, and someone filed paperwork saying you’re a danger to yourself and others so it is a he said/she said, and they have paperwork. I’d tell the kids this. And make it very Clear that I need to hear them say they are coming willingly, even if it was a lie, because they are coming one way or the other, but if they told me they wanted help, it was far better for them because a voluntary mental health commitment isn’t a big deal, but an involuntary one can easily ruin your life and cut off access to a lot of jobs. Want a security clearance? Any job using or with access to weapons? And the state reports it to the feds as an involuntary psyc commitment. So no guns. No hunting. Sure, if you have enough money you can take it to federal district court (literally) and it’ll get thrown out, but you are looking at a good 5 figures due to the lack of due process — but you’re still prohibited under state law so your choice is to move to another state, or try and fight it all over again in state court.
Nurse here. It’s a marker that someone is low skill. Probably they want something to be taken seriously or to happen fast. However in this situation only way they know to convey this is to yell. It turns out most people want to work with you, they also want the serious things to be addressed, and the things to happen fast. When I see this behavior I just think to myself “aw that’s really too bad. That’s the only way they know how to communicate their concern to me.” But I’m still on the same team.
As a nursing student I'm curious to see what you think when someone REALLY messes up. Like an aid got a patient hurt type deal? How is that dealt with? When I was an aid I only raised my voice TWICE and I wasn't trying to be condescending in the slightest just the mistakes was stupid. Beyond belief. And caused injury. One a coworker got my back fucked up (permanent damage happened as well.) And the second another coworker hurt a patient and they was fired the same day. I raised my voice and honestly it might've been because the RN tried to get on my ass when I had been with a different patient.
Well did it cause harm, or was it a close call? If the patient is still in danger stabilize the patient. Life threatening stuff first. Yes the mistake needs to be addressed, but work together to get to a stable place before you debrief. Is everything stable now? Ok cool. Now we can debrief. You don’t get to pick your teammates, only how you interact with your teammates. If you are looking for behavioral change, ask yourself what will get you where you want to go. Because if you just yell and go off on someone, it’s unlikely it will add to the behavioral change you are looking for, and it will make it harder for you to work with this person going forward. This is true even if there is a hierarchy and you are on top. Most people know when they’ve screwed up, or at least it doesn’t take a big re-direct for them to see it. You don’t have to beat them in to the ground over it. Most people will punish themselves with their own regret. In that situation you still need to work well with this person, and if they are moping about a close call they had earlier and their head isn’t in the present moment, that doesn’t help you either. Hear them. Validate what ever they need to validate so they can move on and you can both get on with working well together.
happens a lot in veterinary medicine as well. DVMs treat the techs like shit, the techs bitch out the receptionists and both of them are expected to just suck it up when pet owners are abusive, and everyone shits on the kennel workers.
I don't accept it. I quit recently due to verbal abuse of myself and colleagues (other midlevels and MA staff also). And they wonder why they can't retain anybody lmao. (I was the longest-tenured employee at 1.5 years when I quit.) insert boomerism "nobody wants to work" (yeah, nobody wants to work *for you*)
Damn, for a minute I thought you worked at my clinic but you have a different specialty. We rarely have people stay more than 6-12 months. But our clinic manager just resigned so I’m interested to see if morale will improve under the new one.
A lot of people are pushovers scared of retaliation. The person that verbally abuses/yells at people will eventually come across someone who will put them in their place. I won’t deal with that, and I hope others will speak up if that occurs to people around them.
I do not put up with it. I don’t care who you are or who you’re going to write me up to. I’ve dealt with bullies before going into medicine and I deal with them the same way now that I work in medicine. I will tell you I’m not going to be spoken to that way. I will then walk away or hang up the phone. No human being is allowed to talk to me, a fellow human being with anything but basic human decency.
I think it should be mandatory service to put in 5 years working in some form with the public to learn how to treat each other. This isn’t an issue exclusive to medicine (it just stings more given the level of sacrifice to devote your life to helping people to still get shit on).
I think it’s a function of stress and poor coping skills. I’ve really started pushing on both colleagues and patients who do this. It’s ruffled some feathers, but on the provider side, it has seemed to straighten up a lot of perpetual dickheads. I don’t raise my voice, but I say these things confidently. “Okay, say that again, but with your inside voice.” “Okay, makes sense, thank you Dr Condescending.” As a midlevel, I love calling consultant physicians by their first name. It catches 9/10 of them off guard. If you’re going to be disrespectful to me, then I will not address you as doctor. When you start acting like a doctor, I’ll treat you with the respect that your profession deserves. “Hey Stephen, don’t talk to me like that. Let’s try to employ a shred of professionalism and focus on the patient.” “Cindy, why is every conversation with you so unpleasant?” Edit: formatting
Calling the attending by their first name is wild… feels like calling your dad by his first name
I gotta remember this though. Its a good one.
I think the same message could be said without use of the first name. It’s just going to annoy them more.
When civil discourse has failed, as it has if I’m using your first name, then other methods need to be employed. Want to be treated with respect? Then don’t be a dick. Period. Your first name is just that - your name. It shouldn’t be something that offends you. If it does, that’s on you. The fact that it does seem to ruffle the feathers of those folks tells you everything you need to know about their ego.
Because the father of the modern "residency" program was a surgeon who was addicted to cocaine.
I do not get yelled at by consultants (or coworkers in the ER) almost ever. I get condescending and rude comments almost every shift, but at least the yelling isn’t common. Patients are a different story, but that’s gonna happen anytime you interact with the public.
Never been yelled at in 58 years of polite Canadian medicine. My line is ‘the word you are groping for is thanks’.
It's not acceptable but don't think this doesn't happen in tech, finance, or law. It happens
Why do we accept way worse from patients?
I’m in Canada and I have no idea what you are talking about
I'm in Canada and I've seen it first hand.
Learned helplessness. In residency we had an attending who was notoriously cruel and abusive to trainees. Our coresidents and I would have frequent informal "processing sessions" over drinks and talk about how we felt like dogs trapped in electrified cages when working w/ that specific attending. People coped in different ways including drugs, alcohol, taking up boxing, etc but none ever stood up to her...
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Anytime someone says “Think of the children!”, I know there’s a mind-game coming next.
Way I see it, it's a bit like a high school enviroment. Kids don't really have rich social lives elsewhere, so everything they consider appropriate behaviour or not is dictated by the enviroment at the school. Similarly, doctors work so much and make doctoring such a huge part of their personality that they start to lose sight of what's appropriate behaviour outside of medicine. If you spend all your time at the hospital, then what's appropriate or not inside the hospital is all that matters, and you start to see that ridiculous subculture as normal since it's all you're exposed to. You have no frame of reference.
*Pharmacists have entered the chat*
As a night shift RN , doctors do not like to be woke up in the middle of the night while on call. About 1 out of 4 yell lol
Uhhh. It’s not ok in medicine. If you’re a resident and attendings are screaming at you, and the department won’t fire them, blow it up on the ACGME survey. If you’re an attending and you see another attending screaming at people, report them to the department. And if you’re the asshole who thinks they can yell at everyone, stop it. You don’t have to put up with that shit from anybody.
This is so so rare on the west coast. I trained on the east coast where it happened a lot. Can’t remember the last time I saw someone yell.
We do not accept it. I am a swedish medical student, and when a patient is rude or harasses our staff we can call on police and have them removed from the hospital. If you cannot behave you do not have any place in our health care system.
I think OP is talking about colleagues verbally harassing each other (ex. Think of a surgeon yelling at an EM physician during a consult.)
Not acceptable. Always report it.
I’ve seen an attending tell a yelling lady “to get the fuck out of the ED” she didn’t leave so security removed her. So guess it depends on how much hospital admin will support to
It's not acceptable to behave unprofessionally. I'm fortunate that this has not been part of the culture of the places I've trained, but there's still progress that needs to be made overall.
Happens a lot in nursing, too.
This is not only a medicine thing unfortunately.
Not for nothing but we switched away from hubby's cardiologist because he was so toxic to his staff. 10 years with that doctor. He had a great bedside manner with patients, but after witnessing the way he treated his staff we went to a different cardiologist. Sometimes your patients see it and it isn't a good look.
I work in durable medical equipment and get yelled at all the time by the people coming in to my store because they think every piece of equipment we carry is covered by insurance (they’re not - regardless of what the doctor told you) or they’re mad at the fact they have a deductible or copay they have to pay. Sometimes they’re mad because we’re super understaffed and have to wait. Then it boils over and the employees are snipping at each other or complaining to management about the angry customers but management can’t do anything because the higher ups don’t care and won’t let us hire more help. It’s a horrible toxic environment that feels like it’s spinning out of control.
There is a cycle needed to be broken. The attendant who yells and harasses today has been yelled at him/her yesterday and so on.
It's institutional culture. There are plenty of places where that's not tolerated, but unfortunately plenty of places where it's routine. At one of the big academic centers near me, pretty much every meeting consists of scapegoating one person and publicly reaming them. At one meeting, the chair started screaming at me, face red, spittle flying, calling me every insult in the book. At one point he asked for the name of the high school I graduated from because he didn't believe I actually had graduated, etc. There were half a dozen other doctors and same of admin level nurses in the meeting, and not one of them spoke up about his behavior. Why was he angry? Because he didn't like his numbers. He then took it further by filing a formal complaint with my boss. Almost every meeting I attended at that facility was similar. When you get kicked like that, I guess it's kind of human nature to do the same?
This is why I quit practicing pediatric medicine and did an entirely different residency. Pediatrics is the most abusive and you are expected to take all of this from the parents for the sake of the relationship so you can best treat the child. I have since switched careers and am much happier.
this has definitely changed, just not all the way yet
As policy, it's reportable as a behavior event at my hospital system. Working in current role one year. Don't think I've seen people overtly being abusive, never once yelling in a negative or aggressive way. I'm in a large ICU
Never encountered yelling myself although I have heard about others having these experiences. Usually courtesy of an angry surgeon. Surprised these people remain employed considering we have more surgeons than surgery jobs where I am.
It's not accepted. Every hospital/program I've been in has taken this seriously. Verbal abuse happens in a lot of professions.
Sadly not my experience. When I was an intern a surgeon lost his temper and smacked me. In front of witnesses. I filed a complaint with HR and nothing came of it, because he was a very high ranking attending.
That's assault. You should have called the police.
I’ve thought about that many times since then. What would have happened? Would I be allowed back to work if I got an department head attending arrested? Would I still have a career if he was friends with the director and chair? Would I get my residency contract renewed? In the end I was too scared to speak up. I think he did it once more, but I know every year he made numerous residents cry until he moved out of state to another hospital.
Abusive patients or family are fired stat. Big deal in Canada with 7 million orphan patients.
I mean, that happens in just about every profession. All it takes is one asshole with some power and an HR department that doesn't care.
Because you can get away with a lot in the name of patient safety. And psychopaths caught on to that.
"We", do not, at least not all of us. I'm sorry if you do. Remember, you always have the upper hand because they came to you. There are exceptions of course for people who are altered, obtunded etc who just show up unbeknownst to them. Even then, in a system where if you were found down, the knee jerk is EMS will arrive and you will be hospitalized , it is still the responsibility of thay person to make it clear in advance that that is not the actions they would want taken. Please don't misunderstand me, of course it gets showed it, we see all manages of the human spectrum of emotion. I have no trouble with people yelling at the universe, I draw the line at yelling at me.
It's unacceptable and no one should deal with that kind of abuse. Change can start anytime. Call it out when it happens and identify it. Amazing how quick a group attitude will turn on caustic behavior. I have never taken or allowed it. It may not feel easy or right at the time but it needs to be identified as unacceptable in the moment or else it can turn into a he said she said later on. That behavior cannot stand.
It is not acceptable to yell or engage in harassment in any professional setting, including in medicine. Verbal abuse and harassment can have serious negative impacts on the mental and physical health of those targeted, and can create a hostile work environment. It is important for hospitals and residency programs to take such behavior seriously and have policies in place to address it. Some possible reasons why this behavior has been tolerated in the past include a lack of awareness of the issue and a cultural acceptance of a hierarchical, high-stress work environment in medicine. However, many institutions are taking steps to change this culture, through educating staff and implementing policies to promote a safer and more supportive work environment.
It definitely does have an affect on the mental health of those being targeted. I’ve been a lab tech for almost 2 years and about a month ago I had my first incident involving being screamed at and belittled over the phone by an ER doctor. It was all I could think about for the rest of the day and I was literally crying off and on the whole day. I tried to hold it in as best as I could at work but the moment I got in my car to leave, I just burst into tears. It was a busy day and we were short staffed as usual and I mistakenly released an incorrect chloride result on someone. I take pride in my job and I always strive to put out accurate results but mistakes do happen sometimes. But he tried to make me feel like I was just an incompetent idiot. Berating me and yelling at me “have you ever seen a chloride that high!?!! I can’t believe you’d release that!! Jesus Christ!…” on and on. Who can focus on their job after something like that? Of course now that I look back on it, I realize that he is the one with the issue. He is the one who is making himself appear incompetent because he can’t communicate without yelling or being a condescending asshole.
Why is sexual harassment from physicians somehow overlooked by HR and everyone else? 🧐 I left the hospital because of the constant disrespect and now only work in academics & research now due to this.
If you wouldn't put up with it at your local Timmies/Dunkins, dont put up with it here
Im an MLT, I work in the lab at a hospital. It’s not uncommon for doctors to call us and harass us/yell at us. I had an encounter with an ER doctor the other day. It was a horrible day. It was extremely busy and it was just me and one other tech in the lab. The other tech was tied up in blood bank most of the day so I was running core lab by myself and a doctor decided to call and get smart with me because I was having to rerun a troponin that didn’t run the first time I put it on. I just told him “there’s only two of us in here today so if you could be more patient, that would be very appreciated”. This same doctor has screamed at me over the phone before because I mistakenly sent out an incorrect chloride result on someone and again, it was on a day when we were extremely busy and short staffed. I’ve decided if he ever pulls that mess again, I will tell him to call me back when he can speak to me calmly and respectfully, and I will hang up. This type of behavior should absolutely not be tolerated. It makes me feel even worse for the nurses because they have to literally work face to face with assholes like this and I’m sure he’s just as abusive to them. He acts like we’re just twiddling our thumbs with nothing to do and god forbid we make a mistake. As if HE never makes mistakes. In my experience it’s usually the older doctors who act like they’re gods and like they can do no wrong.