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Investigating Rude, Dismissive and Aggressive Communication Between Doctors Clinical Medicine 2015 Vol 15, No 6: 541–5 ORIGINAL RESEARCH Sticks and stones: investigating rude, dismissive and aggressive communication between doctors Authors: Victoria Bradley,A Samuel Liddle,B Robert Shaw,C Emily Savage,D Roberta Rabbitts,E Corinne Trim,F Tunji A LasoyeG and Benjamin C WhitelawH Destructive communication is a problem within the NHS; Introduction however previous research has focused on bullying. Rude, Destructive or negative workplace communication is recognised dismissive and aggressive (RDA) communication between 1–4 doctors is a more widespread problem and underinvestigated. to be a problem both in the NHS and other organisations and has attracted concern following recent care scandals such as We conducted a mixed method study combining a survey and 5,6 ABSTRACT focus groups to describe the extent of RDA communication Mid Staffordshire and Morecombe Bay. between doctors, its context and subsequent impact. In total, Negative workplace behaviours encompass a broad spectrum 606 doctors were surveyed across three teaching hospitals in and most of the research on negative communication between doctors has analysed bullying or undermining as a discrete England. Two structured focus groups were held with doctors 7–10 at one teaching hospital. 31% of doctors described being subset. However, relatively little work has been done to subject to RDA communication multiple times per week or describe more widespread rude, dismissive and aggressive (RDA) communication between doctors that can also be more often, with junior and registrar doctors affected twice 11 as often as consultants. Rudeness was more commonly defined as workplace incivility. RDA communication is experienced from specific specialties: radiology, general distinct from bullying which is a more persistent and power- based form of abuse most commonly occurring within a surgery, neurosurgery and cardiology. 40% of respondents 2,12 described that RDA moderately or severely affected their department. working day. The context for RDA communication was Doctors who are recipients of bullying and negative communication have increased levels of stress and depression, described in five themes: workload, lack of support, patient 9 safety, hierarchy and culture. Impact of RDA communication and an increased desire to leave medicine. There is increasing was described as personal, including emotional distress and recognition that this kind of adverse staff interaction leads to worse patient outcomes and can represent a patient safety substance abuse, and professional, including demotivation. 13–15 RDA communication between doctors is a widespread threat. and damaging behaviour, occurring in contexts common In order to find out the scale of RDA communication in in healthcare. Recognition of the impact on doctors and hospitals, and the impact it has on doctors, we conducted a potentially patients is key to change. mixed methods study at three teaching hospitals. The study involved surveying doctors to report their experiences of KEYWORDS: Medical education, rudeness, communication, negative communication and conducting focus groups. incivility Methods Survey An online-hosted questionnaire combined multiple choice questions and free text boxes to gather information on: Authors: Amedical education fellow, PGMDE, King’s College 1. Frequency of RDA. Hospital NHS Foundation Trust, London, UK; Bmedical education 2. Context of RDA – who perpetrates rude behaviour? fellow, PGMDE, King’s College Hospital NHS Foundation Trust, 3. Impact of RDA. London, UK; Ccore medical trainee, Oxford Deanery, Oxford, UK; Dcore medical trainee, South West London Deanery, London, The cohort of doctors to whom the questionnaire was UK; Ecore medical trainee, South West London Deanery, London, circulated was defined by lists of current employed doctors UK; Fmedical education manager, King’s College Hospital NHS obtained by the postgraduate medical department and the Foundation Trust, London, UK; Gdirector of medical education, office of the medical director in each trust. It was distributed King’s College Hospital NHS Foundation Trust, London, UK; to three core groups – junior doctors (defined as all in posts Hconsultant endocrinologist, King’s College Hospital NHS <specialty training year 3 (ST3)), registrars (defined as training Foundation Trust, London, UK posts ≥ST3) and consultants. © Royal College of Physicians 2015. All rights reserved. 541 CMJv15n6-Bradley.indd 541 20/11/15 8:38 AM Victoria Bradley, Samuel Liddle, Robert Shaw et al Table 1. Response numbers and rates for each hospital and grade of doctor surveyed. Hospital Junior respondents Registrar respondents Consultant respondents Total respondents Response rate (%) A 90 47 113 250 21 B 28 29 70 127 15 C 76 60 93 229 12 Total 194 136 276 606 15 Doctors received an email invitation to complete the survey or aggression originates from within the individuals’ own and then up to two email reminders. department (16%) and a larger proportion comes from The questionnaire was circulated at three large teaching interaction with other departments and specialities (49%). hospitals, two in London and one outside London over a period Certain specialties were repeatedly and consistently named between November 2013 and February 2015, henceforth known as more likely to engage in this behaviour and these were: as hospitals A, B and C. radiology, general surgery, neurosurgery and cardiology Results were analysed by one of the investigators using (Fig 2). Microsoft Excel. Despite negative behaviour being common and widespread in the survey, respondents were very unlikely to recognise Focus group themselves as perpetrators of this behaviour with 86% of respondents saying they either never communicated in this way The focus groups were held in the early evening on a or only did so a few times per year. weekday and the groups were run by a trained facilitator. Two focus groups were held: one for trainee doctors, with six participants; another for consultants, with four participants. The participants were recruited by email from one of the three (a) 60 hospitals. Questioning was semi-structured based on the data 50 40 34 gathered from the survey to explore a greater depth of data in 28 key areas: % 30 22 20 9 7 1. Experiences of rudeness. 10 0 2. Context of rudeness – what is seen as triggering rude 0 behaviour? DNA Daily 3. Impact of rudeness. Never per year per week Few mes Few mes Few mes Other topics or themes which arose were explored as far per month as useful and relevant. Questioning was open and non- (b) 60 judgemental to minimise bias from the facilitator’s own 50 opinions and perceptions. The focus groups were recorded 40 32 34 and transcribed verbatim. Two investigators independently % 30 17 coded for themes, and met to resolve disparities and achieve 20 11 6 consensus, and a third investigator agreed the final analysis. 10 1 Quotes were tagged with T or C for trainee or consultant 0 respectively, followed by a numerical identifier. DNA Daily Approval for the project was granted as service evaluation by Never per year per week the trust research and development department. Focus group Few mes Few mes Few mes per month participants gave written consent to be recorded and their discussion analysed and published verbatim. (c) 60 51 50 40 Results: survey % 30 21 We received 606 responses in total (see Table 1). RDA behaviour 20 14 11 10 4 was reported to be common. 31% of doctors describe being 0 personally subject to this behaviour multiple times per week 0 or more often (Fig 1). The rates are similar across the three DNA Daily hospitals studied. All grades of doctor are affected but junior Never per year per week Few mes Few mes Few mes and registrar doctors are affected more than twice as much as per month consultants, with 43% of junior doctors and 38% of registrars Fig 1. Combined data from three hospitals in answer to the question: experiencing RDA a few times per week or more, compared to How often do you personally experience rude, aggressive or dismissive 18% of consultants (Fig 1). communication in interactions with other members of staff? Visually The behaviour is experienced from a wide range of sources represented are (a) all respondents’, (b) junior doctors’ and (c) consultants’ within the hospital. A minority of rudeness, dismissiveness answers expressed as a percentage. DNA = did not answer. 542 © Royal College of Physicians 2015. All rights reserved. CMJv15n6-Bradley.indd 542 20/11/15 8:38 AM Sticks and stones my language: ‘ f***ing useless, and was a f***ing waste of Mean of all other 1 space. What are you doing ringing me at this f***ing time in speciales name (total 27) the morning?’ – C2 Other more insidious examples of rudeness included Cardiology 17 undermining, unwillingness to help, sexism and racism: I’ve had situations where people…haven’t listened to me Neurosurgeons 18 because I’m a woman. Other colleagues who’ve not been listened to because their particular ethnicity – T6 Concerns were raised that legitimate negative feedback could be General surgery and 20 surgical speciales confused with rudeness: I got accused of bullying and harassment by one of the F1s, um, because I said, very politely, on the consultant ward round...I Radiology 27 don’t think you did that right…next time you ought to try this and I’m sure it will be fine. – C2 0 5 10 15 20 25 30 % ‘Why does rudeness happen?’ Fig 2. Combined data from three hospitals in answer to the question: Workload In your experience have you noticed any particular departments and/ There was widespread recognition that doctors who were busy or types of staff who are more likely to be rude or dismissive to you or or overworked were more likely to be rude: colleagues? Visually represented are all respondents’ answers expressed as a percentage. …you’re trying to do 15 things at once…my bleep’s going crazy…everyone’s bleeding [and colleagues] want blood products…the lab’s phoning me [about] blasts on the [blood] film, Mr So-and-so is febrile, some external bone marrow RDA behaviour had a marked adverse effect on those subject transplant patient is c****ing out in St Elsewheres.
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