"Most of my friends in medicine have witnessed flagrant episodes of hospital bullying and have juicy tales to tell," Harvard Medical School student Ilana Yurkiewicz writes at Aeon Magazine. "But medical disrespect is usually far less dramatic, dished out in the form of ‘micro-aggressions’: exasperated sighs, a sarcastic tone, the dismissal of alternative ideas."
This comes from an entrenched—and fundamentally flawed—conception of how learning happens, she says: "that harshness creates competence." While most docs, she says, are compassionate caregivers, there remain misunderstandings about how social interactions shape outcomes. They include:
(The idea that) that fear is good for doctors-in-training and, by extension, good for patients. That public shaming holds us to higher standards. Efforts to change the current climate are shot down as medicine going "soft."
The only problem with this treat 'em mean, keep 'em keen kinda thinking is that it runs counter to all of the research.
As we've talked about before, bossing people around backfires because it breeds resistance, reticence, and retribution. In the case of business a shame culture dams the flow of new ideas; in medicine it puts patients' lives in danger.
As Harvard health policy professor Lucian Leape says, a culture of disrespect is a barrier to patient safety, since "it inhibits collegiality and co-operation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices."
As Yurkiewicz contends, good medicine (and really any good work environment) is an ecosystem, with younger and elder docs and nurses and administrators all working in conjunction.
But shaming makes for dysfunction. When the ecosystem's working well, then junior residents ask seniors about things they're confused on, senior residents relay anything they can't resolve to the attending physicians, which allows for the questions to reach the appropriate level of expertise. Then the action goes back down: once a decision is made, the most junior docs carry out the decision and learn by doing. But jerkiness clogs these connections, Yurkiewicz says; "when anger and intimidation flow down, information stops flowing up."
Cultures replicate themselves because senior people model behavior to junior people: "I went through this, so you should to" is a suiting refrain. As the New Yorker has reported, one reason so many of us work insane hours is because our bosses do the same. Same goes for the entrenchment of jerkiness; to not be cruel to your employee is to be "soft," and soft is bad.
To put it in marketing speak, jerkiness needs a rebranding. It should be acknowledged by leadership as idea-stifling rather than as a badge of honor, as sociologist Brené Brown is always reminding us. But it's not that the jerks and bullies are evil; they just have low emotional intelligence, which can be corrected for—given the right kind of conversation.
Hat tip: Mind Hacks