Bedside Manners: Curb your Docs

My senior partner strutted down the hall in our office, "bearing" a close resemblance to Baloo from The Jungle Book. As he drew near, under his breath I could hear the strains of Zip-a-dee-doo-dah Zip-a-dee-ay ... ."

Hiding my smile, I stepped back into my office, closed the door and telephoned Linda, an endoscopy nurse at the hospital.

Whether doctors can be trained or manipulated is not open to question -- you really don't think the pharmaceutical industry spends so much money on pens and pads emblazoned with drug names because they want to make sure our children have enough writing implements, do you? I'm sure a bunch of money has been spent proving doctors are quite suggestible and subliminally directed. But now we proved we could do it in a clinical setting.

The scam: we wanted to see if we could subliminally plant a song in the brain of a physician.

The locale: at the endoscopy suite of our hospital. We would have Linda, one of the two nurses staffing his room, hum a preselected song under her breath while working with him. We chose carefully; it had to be infectious, but not too deviant. Imagine not being able to rid yourself of "It's a Small World!" My role was to measure the outcome. Had the inoculation taken?

It worked, and David had no idea from where the cheery tune had sprung. We had achieved mind control!

Why should you care? Well, much of the responsibility for the ongoing nursing shortage, after low wages and erratic schedules, comes from the incivility of the doctors and colleagues. Not only does this rude behavior lead to staff shortages and departure from careers in medicine, uncivil behavior can have a negative impact on patient outcomes as shown in studies in the intensive care unit (ICU) setting by Shortell (1994) and Knaus (1986). Patients in uncivil and mean environments were shown to have higher death rates or longer stays in the hospital. Civil units had an easier time retaining their nursing staffs. Thus, we need to teach hospital staff to take control of rude behavior in our hospitals, for our patients' sakes and for the staff's well-being.

David had lost the song by morning, so I do not preach that we can change your doctors' or co-workers' overall behaviors, alter personalities forever, or cure cancer. However, when I read about control of obnoxious behavior in others being impossible -- that you can only change your own reactions to it -- I say horse feathers! It is a passive and psychologically injurious way to let others wound you with verbal aggression.

Physicians and co-workers are smart and trainable. You will not be able to affect a life or persona change, but others can be trained to act in an appropriate manner when around you, the trainer.

A vicious pit bull can be trained, but is no less vicious. A retriever is trainable, and is still lovable. We do not propose to change the basic nature of the beast, just to school it in appropriate collegial behavior.

At most hospitals when a doctor gets "cranky," he or she takes it out on the nurses. The verbally abused nurse speaks to the charge nurse, who asks her to report it in writing to administration. Several days later, it is received in administration, reviewed by committee and a form letter is generated after the next scheduled committee meeting in telling the doctor to be nicer to the nurses, but being very vague on details. The doctor is miffed. He or she can't recall the incident, and had someone told them of the problem, then they could have corrected their actions. Miffed, the doctor goes on rounds, and the hospital continues to spin on its unending cycle.

What is this like to the offending doctor in dog terms? Think of the doctor as a newly acquired puppy who has just piddled on the living room rug. You're upset, but don't say anything to the dog. Then one month goes by, and ...WHAM! Out comes your rolled up newspaper!

And the puppy thinks, "Huh? What'd I do?"

Not the way to train a dog, is it?

You've got to hit doctors with the newspaper at the time of the event if you want to make a change in their behavior. It will take commitment on your part, but you will end up with a well-trained doctor over time.

We need to teach specific behavior training techniques for verbal aggression in the hospital setting. The figurative rolled up newspaper is quite direct, and most doctors are not brave enough to face the offender down. However, there are some oblique and even subliminal behavior modifications you can implement to control the behavior of your doctors and unruly colleagues.

If you choose to take control and change your working environment, you must remember three things:

• Be persistent. Following the puppy analogy, the puppy doesn't get it right with just the first whack. Don't give up and return the puppy to the pet store when he piddles for the second time.
• Be consistent. The puppy shouldn't get mixed signals. Every infraction must be met immediatelywith the same measured newspaper whack. If the puppy sometimes gets away with adverse behavior, where does that lead? A very confused, poorly behaved dog and a new, darker colored living room rug.
• Be insistent. You deserve a nice, sane, friendly, courteous, collaborative workplace. You have the power to train your colleagues and doctors to make it so.

Just do it. Curb your docs.

Patricia Raymond, MD, FACG, a practicing gastroenterologist, leads nurses and physicians to "Turn Care Inward." She has presented on self-care for the endoscopy nurse and on civility in the endoscopy unit, most recently at the 2002 SGNA in Phoenix. Her book "Bedside Manners: How to Cure the Incivility Epidemic in Your Hospital" will be completed in 2003. Visit www.RxForSanity.com to read the book in progress.

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