On Rudeness

‘Hey Tessa, I didn’t realise you were such a genius.”

I was on my way back to ED from my lunch break and the ortho reg was sitting laughing with one of our locum SHOs.

I smiled nervously, “Oh! Thanks for coming to see the patient.”

“I didn’t realise you were a genius”. He said it again. He was still smiling. It was weird.

“I’m not sure what you mean, but something about this is making me nervous”. I was trying to make a joke of it. But let’s be honest, I’m not a genius, so I had a sense that something wasn’t right.

“You told my patient that they could eat and drink. They need an operation and now they aren’t fasted. Thanks for that, genius!

I have since thought of a gazillion things I could have said. Like, “I didn’t tell them they could eat and drink!” or “Hang on, there’s no need to be rude”, or “You’re setting a terrible example to this locum SHO about how to be courteous to your colleagues” or “It doesn’t cost to be kind!”.

He walked away before I could say anything else. I’ve spent the weeks since pondering over it endlessly.

Yes, we work in busy and stressful environments. We have all snapped from time to time, but it doesn’t mean you’re a bad person or a terrible doctor. But at the same time, we need to let people know that it’s not ok to be spoken to like that. We must set a good example for our juniors to help change the culture and preserve our self-respect. My reaction was disappointing (at least to me, anyway). How should I have done it better?

The DFTB team asked a few docs whose opinions we value – how should you respond when someone at work is rude to you?

Here are the collated answers and themes from: Dara Kass (DK); Vic Brazil (VB); Simon Judkins (SJ); Damian Roland (DR); and Natalie May (NM).

Most people aren’t actually horrible people who want to see you suffer…

In the hectic nature of acute medical practice, clinicians can become tired,  hungry or a deadly combination of both. This can lead to frayed tensions and communication challenges. Sadly, rudeness is often a part of the normal process rather than an unacceptable professional dynamic. DR

And sometimes, it’s possible it wasn’t meant in the way it came across…

There are many perceptual challenges around ‘rudeness’ as there is no strict definition of what it is. You know it when you see or hear it, but you can’t always describe it. Many people honestly don’t believe they are being rude, or if that is being too charitable, that the impact of the tone of their voice or choice of language isn’t considered. DR

We all have plenty of everyday reasons to feel some anger at work…

Usually, the person is rude because they are frustrated with the system, the medical issue or their own lives. Rarely, the patient’s rudeness is just a personality disorder, and I try to interact with them as little as possible while delivering excellent care. 🙂 DK

As a senior, if this rude behaviour happens, we jump on it early, but it is also essential to listen to both sides of the story; there is often a tale of grief/stress on the other side that we also need to recognise and support. I don’t think there are many true asses out there, but many people who feel unsupported and vulnerable. SJ

Try to look on it in the most positive light and give them the benefit of the doubt…

Follow Jenny Rudolph’s #WTF2WTF … take a breath and think why? Trying to be generous in possible motivations might help. VB

But if it’s rude, we need a strategy to deal with this. The key is to reframe it – move away from it being about the words they used or their tone when they spoke to you and try to find some common ground…

I am rarely responsible for the cause of their frustration but try to validate their experience and see what I can do do diffuse the issue. DK

Try to focus on the patient, i.e. both parties need to focus on the patient and not get lost in a personal dispute…

Frame all conversations with colleagues in the context of the patient’s needs – and believe first and always that your colleagues have the patient’s best interests at the centre of their intentions. NM

It’s also important to acknowledge the positives. Being kind and professional make for a happier work environment for all…

Emphasise how important good behaviour is e.g. ‘we really want to get along with our work colleagues here’. VB

And an important point to consider is that being right and being rude are two separate things. There will be times when something doesn’t go smoothly, and it might be your fault. The person being rude may be right i.e. you did indeed do something wrong, but that doesn’t give them the all-clear to be rude…

Separate the issue from the rudeness i.e. the person being rude might actually be ‘right’. Still, the conversation should clarify that the issues are separate and that being right doesn’t justify the rudeness. VB

Debate around patient care is vital, in fact it is an essential element of patient safety. However, there is no reason the tone of that debate should cause discomfort to those having it. DR

There will be times, where you need to just confront the problem and ‘call it’. Choose your language carefully…

Use words like ‘disappointed’, ‘surprised’, and ‘what a shame’ VB

I tend to call things out, “I’m really sorry, but I don’t think I deserve to be spoken to like that. I appreciate your different point of view but how can we resolve this in the best interests of the patient.” Written down, playing the ‘patient card’ sounds glib, but in practice directing attention towards the one thing you have in common with the other person tends to clarify thinking. DR

When confronted with rudeness, pause – count to five in silence (it might need to be ten!) – then prompt reflection (the sentence I’m trying to use is “you might like to think about how that came across”). NM

It’s tough when you’re not expecting it..my responses vary but usually involve highlighting the unprofessional behaviour, asking them to reflect and continuing the conversation when they are ready…like I do with my teenage boys! SJ

‘Calling it’ doesn’t mean starting an argument with them. Otherwise, that defeats the purpose of your response…

Avoid interrupting or talking over people who have already escalated their behaviour – this fire will usually burn out on its own and is best countered with coolness, not more fire! NM

If rudeness/hostility continues, use graded assertiveness or giraffe feedback to shift focus to immediate needs and patient safety. Rudeness is potentially a patient safety issue. NM

It might not be appropriate to respond at the time for a multitude of reasons, and that’s ok…

There is nothing wrong with having the conversation later (and in many respects, it might be better)….keeping the ‘marriage counselling’ lingo focused on behaviour and impact -“when you did x, I felt like y” VB.

You don’t need to perseverate on your own about this, speak to your colleagues. They’ll all have been in a similar situation.

Consider a cold debrief after such incidents with a trusted colleague and appropriate escalation as warranted by the incident (this will vary). NM

There is also nothing weak about others having these conversations for us, at least to open it up…. “My intern is pretty upset about a discussion you guys had. I don’t know what happened, but the impact was pretty bad. I thought you’d like to know as I doubt that was intended …..” VB

The other approach we use with our DITs is to suggest that “ it seems that we aren’t going to agree on this issue, so I think we should end this conversation. I’ll ask my Boss to call your Consultant, and they can discuss a solution “. SJ

These lessons shouldn’t be just for one someone speaks rudely to you. It’s our job to look after our colleagues too…

I would also like to point out that calling out rudeness when witnessed is also important. As a senior clinician, while it is easy to pretend you haven’t overheard conversations, letting things go because they don’t directly affect you propagates a culture in which the status quo remains acceptable. DR

Sometimes, your response will make the person realise they were rude. And they might even apologise. Allow them to do so!

Allow space for insight and apology – if the person being rude apologises, accept the apology and move on. Harbouring negativity helps no one. NM