Louisville Medicine Volume 69, Issue 4 - Page 6


Bullying continues to be an important problem throughout our culture in a variety of settings , including health care . We need to identify terms so that we do not mistakenly label a particular behavior or interaction . It ’ s important to distinguish between rudeness , meanness and bullying , so that we know what to watch for and when to intervene .

Rudeness is saying or doing something , heedlessly or with intent , that violates usual courtesy and consideration for others . A few examples include : failing to acknowledge another person ’ s presence , ignoring other people ’ s greetings and well-wishes , or brushing past a coworker without so much as a nod or a greeting . It ’ s rude to use crude language . On their own , these behaviors could appear as elements of bullying , but when looked at in context , incidents of rudeness are often spontaneous . Rude behavior stems from thoughtlessness , bad manners or narcissism ; it offends people , but is not primarily meant to hurt someone .
Meanness is purposefully saying or doing something to hurt someone . The difference between mean and rude is intentional hostility , the urge to hurt someone ’ s feelings . People are hurtful when they denigrate others by criticizing anything they can find . Meanness is often rooted in resentment of others ’ prowess or success , with feelings of personal inadequacy that give rise to an effort to elevate themselves at the expense of others . People who nurse grudges and fail to forgive others are often mean . People who feel chronically unappreciated can become mean .
Bullying is physical or verbal aggression that is repeated over a period of time and , in contrast to meanness , involves an imbalance of power . Bullies pick on others due to their insecurity , incompetency or both . Experts have identified three key elements of bullying : an
4 LOUISVILLE MEDICINE intent to harm , a power imbalance and repeated acts or threats of aggressive behavior . These behaviors may be physical aggression , verbal aggression , relational aggression ( threatening the relationship ) or cyberbullying .
Starting with physicians and leaders , we need to pull the log out of our own eye first and make sure that we first do no harm , to anyone , including our colleagues and teammates , as well as our patients . We need to lead by example , with compassion and determination for all . Although it is now much less common for physicians to bully medical students , residents and other team members , it does still exist . Disrespectful behavior remains all too common , causing heartaches and misery among all health care workers , crossing all disciplines and workplaces .
The American Medical Association Code of Ethics states , “ A physician shall uphold the standards of professionalism , be honest in all professional interactions , and strive to report physicians deficient in character or competence or engaging in fraud or deception to appropriate entities ,” ( Principles of Medical Ethics , AMA 2009 ).
A study done by the Institute for Safe Medication Practices ( ISMP ) reported that nearly 40 % of health workers chose not to bring up particular patient medication concerns to the doctor , because the doctor was overbearing . 1 The ISMP studies also show that disrespectful behaviors involve peer-to-peer , inter disciplinary staff , including non-physicians , and both genders equally . Matthew Grissinger , RPH found that disrespectful behaviors involved peerto-peer interactions as well as physicians to other professional and non-professional staff . He studied bullying , incivility and intimidation in health care and reported 1 the most common infractions below :
• Negative comments about colleagues or leaders ( encountered