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Medical Matters – Respectful communication: a core requirement for the future of our profession
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Physician Assistants, Physicians, September Messenger 2021 |
Posted September 10, 2021
Read time: 3 minutes
These past few years have been incredibly stressful for physicians in Alberta and across Canada. On a daily basis, I’m impressed by the dedication and professionalism I see in the vast majority of Alberta physicians. However, I’ve also seen stress and frustration expressing itself in many different ways. In a small number of physicians, these frustrations are being expressed in how we communicate with each other as colleagues. Over the past two years, I’ve seen public attacks against colleagues in both mainstream and social media that are not grounded in the professional and collegial way we should all expect from the medical profession. It’s so bad at times that some physicians are unwilling to express an alternate perspective for fear they will be publicly shamed. Without question, these actions come from a small number of physicians, but they can have a significant impact on everyone and really shouldn’t exist at all.
The reason I bring this up here is because I believe the profession of medicine is at a key inflection point. The practice of medicine 10 years from now will be considerably different than it is today and for our profession to survive, we need to embrace a respectful and collegial approach to our communications with each other.
It’s incredibly important for any physician to feel they can share their opinions and perspectives without fear of shame or reprisal. This allows us to capitalize on the wisdom that comes from diverse thinking. The evidence is very clear: diversity of thought leads to better decision-making and in medicine, this means better patient outcomes. It’s therefore essential we not suppress other opinions when we share ours. This is not about winning or losing an argument. It’s about learning from and being open to the perspectives of others. We are never all going to agree with each other and that’s okay. However, we need to be respectful in how we share our thoughts and how we open up to other ways of seeing a problem, or we will inevitably make mistakes.
There are times when answers to questions may seem easy if you’re not directly engaged in complex issues, but we need to be careful not to pass judgement without fully understanding the circumstances in which decisions are made. Prior to deploying to Afghanistan, I remember thinking how simple the solutions seemed to be for the complex problems they were dealing with prior to my arrival. However, once I was put into the battle space, the things that previously seemed simple were far from it. The best support I received was from a highly experienced Director of Operations in Canada, who once told me he would never judge the decisions I made in the battle space because I was the only one with all the insight in the moment when and where the decision was made. He was always there for advice and guidance, and our conversations were always collegial, even if he was trying to understand why I made some decisions. From that, I’ve learned unless I’m in the identical position as the person making decisions, I never judge the decisions others make until I have a much greater understanding of the surrounding facts and circumstances. I’ll admit I’m not perfect with that, but I do my best every day.
As professionals, we should always seek to better understand other people’s perspectives and opinions. We don’t need to agree with them, but it’s essential we understand them. The CMA Code of Ethics & Professionalism, which CPSA has adopted, lays it out very nicely:
- Treat your colleagues with dignity and as persons worthy of respect. Colleagues include all learners, healthcare partners, and members of the healthcare team.
- Engage in respectful communications in all media.
- Take responsibility for promoting civility, and confronting incivility, within and beyond the profession. Avoid impugning the reputation of colleagues for personal motives; however, report to the appropriate authority any unprofessional conduct by colleagues.
I realize these are difficult times and there are no easy answers to the many complex problems we’re grappling with. We have so little control over what is happening around us, so let’s focus on what is within our control. Let’s be respectful and collegial while both listening to and sharing our diverse thoughts, opinions and perspectives.
When the government and the general public beginning speaking with respect for our knowledge, experience, education and the respect we deserve THEN and ONLY THEN preach to us about speaking respectfully. My patients have taught me that only using ultimatums and profanities during this pandemic get heard.
Hi Ash, thank you for taking time to read my article and share your thoughts with me. There is no doubt we’ve seen changes in people’s tone and way of speaking throughout the pandemic—we’re seeing people get more defensive and aggressive, doing what they feel is necessary to protect themselves and their families. I’m not saying this is right or justified, but I empathize that many Albertans are experiencing fears and uncertainties, which is likely a large driver of these disrespectful behaviours. All I can do is share with you what my perspective is. Far too often I’ve seen aggression that is followed by more aggression only to escalate to harm. Rarely, if ever, have I seen harm result when we meet aggressive behaviour with kindness. As professionals, we have a chance to deescalate the anger and aggression. I’ve shared before that respect goes both ways, and physicians deserve to be treated with the same respect and dignity we show our patients. I’d like to thank you for your hard work during the pandemic—please take care.
I hesitate to agree with this commentary. “Respectful” is defined very differently by different physicians. I have witnessed disagreement being labelled as “disrespectful” and “polarizing” when what I observed was not disrespectful but just disagreement. I have witnessed physicians label comments that make them feel uncomfortable as “disrespectful.” Just because it makes a physician uncomfortable, that doesn’t automatically make it disrespectful. What I observed was physicians receiving criticism and feeling uncomfortable with it and immediately labelling it as “disrespectful” rationalizing that this criticism can, therefore, be dismissed since it hurt their feelings.
Just because a physician feels shame when a colleague is commenting, that doesn’t automatically mean that the colleague was shaming them. Maybe the physician feels shame because what he/she did was shameful.
When a physician dismisses and characterizes every criticism as “polarizing”, I think this is also disrespectful.
When a physician is dishonest or misleading to his/her colleagues, I thinks this is also disrespectful.
When a physician ignores and dismisses colleagues who are trying to discuss concerns or worries, I think this is also disrespectful.
When a physician gaslights, I think this is also disrespectful.
However, it doesn’t appear that this commentary addresses the subtle disrespect that comes from physicians. It only seems to address words that are characterized as “disrespectful”. It doesn’t appear to address the actions or inactions, microaggressions, and subtle digs which I think are just as disrespectful, moreso when it comes from physician leaders who have provincial and national platforms.
I think about my patients. Maybe some of their comments could be considered “disrespectful” but I wouldn’t characterize their comments as such because I’m in an authority position and my patients are scared, sick and vulnerable. Those in an authority position don’t exclusively hold the moral high ground in respect. Those in authority have an even higher responsibility to be respectful. Sometimes I wonder if what you call “disrespect”, I would call “accountability.” I wonder if labelling comments as “disrespectful” makes it easier for physicians to avoid accountability.
This is probably where I disagree with you. I don’t think respectful communication is the cornerstone of our profession. I think it’s accountability, humility and best interests of the public. If a doctor needlessly puts a patient at risk but used nice words to do it, that’s still disrespectful. And it’s still wrong.
Hi Lizette, thanks for sharing your thoughts with me. You raise some interesting points regarding what constitutes respect and disrespect in different contexts, and I don’t disagree with you. In fact, your point actually supports what I’m trying to say. We all need to be careful in understanding what our intent is versus what impact we have. There are many ways to share feedback with someone that can be very constructive and valuable, and there are ways that feedback can come across as disrespectful. There is no reason why we can’t hold each other to account, but we must do it in a way that the other person still feels respected. We can’t always control another person’s response, but we can improve how we communicate and share our thoughts that can decrease the risk.
As for your points on people’s actions, you are 100% correct. Actions are a form of non-verbal communication. Everything we do demonstrates respect for others and we all need to be conscious of how we treat other people, not just what we say to them. You’re absolutely correct that doing right by our patients involves so much more, and without question that is also a cornerstone of our profession, but how we do that is so very important. Thank you for your work during the pandemic. Please take care and all the best.
Well said- don’t judge a person until you’ve walked a mile in their moccasins- and even then..,,
Thanks for sharing your experience in Afghanistan.!
Hi Muriel, thank you for taking time to read my message and commenting. All the best.
Well said. Thank you.
Hi Brad, thanks for reading and taking time to comment. Please take care.
Thank you Dr. McLeod for a very timely and important message to the profession. Medical leaders as early innovators often find themselves at the forefront of change and that can be a very lonely position. Disrespectful communication on a public platform further isolate valuable leaders at a time that they need support.
Well said.
If physicians choose to be leaders, it is the bed they made. They need to learn to lie in it. Leadership is a responsibility that physician leaders have chosen. Leaders can not expect unending praise without their fair share of criticism. If they can’t take it, then they shouldn’t have chosen to be a leader. And if they choose to be a leader, they shouldn’t knowingly lead people to their death by poor decision-making and expect not to be criticized. If leaders lead poorly, then they are not valuable. They are dangerous. If leaders go against front-line workers or the needs of the public, then they are not innovators. They are dangerous. And if we are only supposed to give them unmitigated support, then we are not doing them any favors. How can leaders learn how to lead better unless they are criticized and held accountable to their decisions? If leaders can’t manage to put aside their hubris and victim-complex for 5 minutes to try to hear what people are saying, understand the fear and worry, empathize, show compassion, reflect on their actions to try to become a better person and a better leader – then they didn’t deserve the leadership position in the first place. People are becoming sick and dying. While I’m trying to keep them alive, it’s not on my priority list to not hurt a leader’s feelings.
Hi Ernst, I’m glad you enjoyed my message and thank you for sharing your thoughtful comment. Take care.
Dear Scott,
I appreciated your thoughtful editorial, urging us not to judge others, to treat everyone with respect and consideration, as they go about their jobs.
Unfortunately our human history is littered with examples (Dr Thomas Parran Jr and Taliaferro Clark [Guatemala and Tuskagee Syphilis experiments]. Dr Donald Cameron (Montreal LSD experiments]; Dr Percy Moore and Dr Frederick Tisdall [Residential School Malnutrition experiments]) who continued their ‘work’ despite severe adverse patient outcomes being known.
You are correct- we cannot know all of the factors that led to their “battle space” decisions.
Fortunately in Alberta medicine is (or was?) a self-governing profession. We have (do we still?) that duty. While individual doctors have been whispering/ shouting/screaming their protests to the wind as people die in this province of a virulent infection that is being better controlled in many other jurisdictions, our College has not lent its voice to protect the public.
Doctors who raise the alarm (Dr Peter Bryce, Residential Schools, Dr John O’Connor, Fort Chipewyan) are often not heeded. It was years before Dr O’Connor’s observations were confirmed and vindicated.
As physicians there are times when our actions result in bad outcomes. We all make decisions that in hindsight were not the best. Hindsight is 20:20 and all that. But when circumstances change and the results of those decisions are apparent (people are dying, and the set course is is not being altered )– doctors have a duty to speak up and not be silent.
I don’t want to judge the actions of our Medical Officer of Health. But the College, as people are dying in this province, has an obligation/responsibility to look into the “surrounding facts and circumstances”. And judge.
AGREE.
Hi Mark, thanks for taking the time to write in and share your thoughts. All your points are correct and without question hindsight is a wonderful thing. CPSA does have a responsibility to look into the facts and we do just that. We also pass judgment after we have all the information. However, we don’t do that in a public space unless it goes to hearing. Complaints are always judged based on the unique circumstances of each case. Many times what may seem obvious at first glance turns out to be far more complex when we dig into it. All we ask is that the profession recognize that sometimes there is more to the story than what is reported publicly and not be quick to place judgment. I’m confident as a physician you would not want a complaint against you shared publicly without you being able to explain the circumstances behind the complaint. I know I wouldn’t. Thanks again for sharing your thoughts. Take care, Scott
Scott… thank you for sharing your wisdom. We indeed are at a crux regarding civility and collegiality. We are well past the time when we tolerated certain behaviors and communication styles. But it takes healthy relationships and resilience to be able to resist erosion of professional communication and civility.
Hi Douglas, thanks for commenting. I agree, everyone should be able to expect mutual respect in every interaction, period. It’s so important, now more than ever, that we take care to communicate with respect and dignity and hold those around us to the same standards. Thanks for your work during this pandemic—please take care.
I agree 100%
I would also point out that I feel it is my responsibility to speak out when I disagree with policy or technical issues that adversely effect my patients.
I do not want to be in the position a year from now thinking to myself that “yeah Bill you were right about the aerosol path being as important than the contact & droplet path – if only you had been more vocal we could have prevented more illness and death. – if only the college would have been more vocal about professional responsibility to do the right thing vs follow government directives that have been guided more by economic considerations than medical ones. And I do realize we all have ideas about what is the right thing to do – where does the college fit in here?
Being from the worst zone in the worst province in Canada for managing Covid should indicate that change is needed. Not more of the same.
I do struggle to be courteous at times because it is so frustrating to put all those years into my practice and have to abide by decisions that are not based in the latest science and not in my patients best interests.
Trying to manage a pandemic by assuming the best possible trajectory for an outbreak and not preparing for something even a little bit worse strains the bounds of professional behaviour surely.
Accepting the use of a surgical mask for protection when it is quite evident that an N95 respirator would provide better protection is another example. No down side – no excuse not to adopt.
Hepa filters for poorly ventilated hospital rooms and classrooms etc.
The AIDs epidemic in the 80’s was scary because we didn’t know much about it. Covid is scary because we know a lot more but we are still be ruled by political considerations more than by rigorous science.
Hi Bill, thanks for your comment. My intention here is to emphasize the importance of ensuring we as a profession can have respectful dialogue, even when we don’t agree. Our profession can benefit from having healthy, professional debate and hearing out and seeking to understand others’ perspectives without resorting to harmful personal attacks or blame and shame tactics. Throughout the pandemic, CPSA has actively encouraged physicians and Albertans to do the right thing by adhering to public health measures and guidance, including getting vaccinated, and especially by being kind to one another through these difficult and unrelenting times. We’ve also published a number of guidance documents, updating them regularly as the situation evolves, aimed at supporting physicians, clinics and facilities in minimizing risks and keeping staff and patients safe during care interactions.
Too bad I wasted my words. I should have just shared this:
https://www.theglobeandmail.com/opinion/article-im-tired-of-kindness-gaslighting/
Dr. Horton writes a response better than I could have dreamed. In particular:
“Think about the kindest people you know. There’s a good chance they espouse another quality that tends to co-exist with kindness: humility. Humility means they aren’t spending time lecturing other people on how to behave. They’re out in the field, doing the actual work.”
“Please stop talking about “kindness.” If you’re a politician, medical expert or government official enacting or defending plans that have resulted in thousands of people getting unnecessarily sick and dying, you have no right to talk about it. If you’re a health care worker, set realistic standards for yourself and just do your best. And if you’re one of the people pushing this system to the brink through your actions and choices, instead of lecturing the rest of us about kindness, you should save your breath. I’m sorry to say I think you’re going to need it.”