Incivility in Health Care: Strategies for De-escalating Troubling Encounters
With rudeness, discrimination, and violence on the rise, how do we take care of our patients while protecting ourselves?
Fam Pract Manag. 2019 Sep-Oct;26(5):8-12.
Author disclosure: no relevant financial affiliations disclosed.
Copyright © 2019 Amaryllis Sánchez Wohlever, MD.
While in traffic last month, a man noticed my failed attempts to reach the exit ramp and began to motion other drivers to let me by. His random kindness got me to the airport on time. At the grocery store, a teenager sprinted over to hold the door open for me. I praised him for being so polite and considerate. In my neighborhood, a six year-old boy fell off his bike, so I washed his skinned knee, put a bandage on it, and helped him fix the chain that came off his bike gear. His sweet smile was my reward.
These stories exemplify the backbone of a healthy society: civility. The very word evokes what it represents: courtesy, respect, kindness, good manners, politeness, and considerate actions toward others. You know it when you see it, and its absence can leave you empty, anxious, or even afraid. Civility entails a certain yielding, a voluntary submitting to one another with the understanding that we're all sharing this human experience, together.
Studies have shown that six in 10 physicians have been subjected to offensive remarks about their race, gender, ethnicity, age, or weight, and health care workers commonly face verbal abuse, physical threats, or worse by patients and others.
De-escalation strategies, such as taking a timeout and responding instead of reacting, can help in some situations.
When incivility escalates, physicians must discern when it is time to get help or remove themselves from the situation.
Health care institutions have a responsibility to create a culture in which physicians feel protected.
WHY SPEAK OF CIVILITY IN HEALTH CARE?
Perhaps mirroring trends in our nation, rudeness, anger, and toxicity are becoming all too common in health care settings. In a 2017 survey of more than 800 U.S. physicians, six in 10 reported absorbing “offensive remarks about a personal characteristic in the past five years,” including comments about the physician's race, gender, ethnicity, age, and weight.1 According to the survey, and perhaps not surprising, female physicians face bias more often than males.
A 2015 study of 5,385 hospital workers found 5,576 incidents of verbal abuse by patients or visitors over a 12-month period in addition to 2,260 physical threats and 1,180 instances of physical assault.2
Studies also reveal a lack of resources for physicians to handle prejudice or abuse. Only 24 percent of physicians state they document such interactions in the medical record, and only 10 percent report such incidents to an administrator. Alarmingly, 60 percent of physicians reported not even knowing whether their institutions had a “formal process to initiate when patients discriminate” against a member of the medical team,
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1. Tedeschi B. 6 in 10 doctors report abusive remarks from patients, and many get little help coping with the wounds. STAT. Oct. 18, 2017. http://www.statnews.com/2017/10/18/patient-prejudice-wounds-doctors/....
2. Pompeii LA, Schoenfisch AL, Lipscomb HJ, Dement JM, Smith CD, Upadhyaya M. Physical assault, physical threat, and verbal abuse perpetrated against hospital workers by patients or visitors in six U.S. hospitals. Am J Ind Med. 2015;58(11):1194–204.
3. Haelle T. Physicians who experience patient prejudice lack resources. Medscape Family Medicine. Oct. 18, 2017. http://www.medscape.com/viewarticle/886711.
4. Porath C, Pearson C. The price of incivility. Harv Bus Rev. 2013;91(1):114–121,146.
5. Porath CL, Gerbasi A, Schorch SL. The effects of civility on advice, leadership, and performance. J Appl Psychol. 2015;100(5):1527–1541.
6. Viglianti EM. Sexual harassment and abuse: when the patient is the perpetrator. The Lancet. 2018;6736(18):31502.
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