Orders. That’s what we doctors give to nurses, technologists, and other so-called ‘ancillary’ healthcare workers. We’re telling, not asking, them to do something our patient needs. That’s how the system works, and for good reason—someone has to sit in the director’s chair and maintain consistent vision.
Like the military, medicine has a hierarchy, clearly defined and known to all. This promotes efficiency, delineates responsibilities, and generally functions well. Communication lines are set; players know their boundaries. The accepted argot does not rely on niceties, and everybody’s fine with that.
Too often, though, it seems power really does corrupt: doctors behave badly, treating those below them on the ladder with scorn and condescension. Yes, we work too many hours, we stay up all night on call or miss our kids’ games because we’re in the OR, we don’t have time or energy to exercise, and we are ever mindful that the buck stops smack on top of us. We’ve spent a big chunk of our lives in school, and we know an amazing amount of stuff. But that doesn’t make us gods, or entitle us to act like jerks.
Recently a colleague blew up at one of our techs. She’d been trying to help him with an urgent scan, and pointed out an error in his order. Later he apologized, sort of, but insisted that his rank trumped all and should have been respected.
Rudeness is popping out all over these days, not just in medicine. Like other nasty things, it tends to be contagious, and little lapses can have larger consequences—studies have shown, for example, that patient outcomes are worse in ICUs where incivility is rampant.
Perhaps our culture needs to step back, do a little yoga breathing, and get our collective blood pressure down a notch or two. Courtesy isn’t just a virtue, it’s crucial for society to function. Respect is definitely a two-way street.
This essay aired on KQED-FM (88.5 in the SF bay area) on 3/22/2010 as part of its ‘Perspectives’ series. See their website for downloadable MP3. (program = perspectives; search = peggy hansen)