Lewd, Crude, and Rude Behavior in Clinical Practice
A very interesting article in this month’s Psychosomatics Journal that discusses a subject that is rarely written about in medical literature – lewd, crude, and rude language and behaviors are often heard and seen in clinical practice.
The authors write “as physicians, our actions—voluntary or involuntary, conscious or unconscious, verbal or nonverbal, overt or covert – characterize our roles on treatment teams and ultimately impact the care of our patients. As a result, an awareness of our behaviors and an ability to adapt them to different clinical situations are essential to providing the best medical care and are a required part of medical training. In psychiatric care, where analysis of relationships, actions, and words informs both diagnosis and treatment, the importance of behaviors is even further amplified.”
Discussed are appropriate and inappropriate ways to interact with colleagues, staff and patients. The authors also suggest management strategies (e.g., psychological, behavioral, and pharmacological) and ways to interact with various difficult personalities when a conflict arises.
In general, isolated examples of inappropriate behavior in a hospital setting are commonplace and often of little consequence (e.g., short-tempered or irritable exchanges between generally well-intentioned and well-behaved professionals who might be particularly fatigued and under tight time constraints). However, patterns of rude behavior can have important ethical implications for patient care. For example, patients who feel intimidated by their physicians may be less likely to ask relevant questions or fully disclose important medical information.
While professional licensing standards serve as powerful modulators of physician conduct through language that admonishes the use of profanity and disruptive physician behavior. In fact, most hospital-based and licensing body disciplinary cases fall under the broad category of unprofessional or unethical conduct. This language, perhaps intentionally vague, includes behaviors such as berating patients or co-workers; shouting; making sexually inappropriate comments or advances; making racist statements, and using profanity.
The authors quote a 2008 article by Kahn in the New England Journal of Medicine on professional etiquette, “being an example to others is not an option; it is inevitable in virtually every interaction on the part of the physician. Even walking the hospital corridor, conversing with a colleague, patient, or visitor, the physician is registering with passersby . . . To your juniors, your actions take on normative qualities.” He continues, “that physician empathic to and beloved by patients but denigrating in dealings with nurses, social workers, unit secretaries, transporters, housekeepers, dietary staff, and others wears a false halo.”