Tuesday, February 28, 2017

Curb Your Unprofessionalism

I've been told my use of foul language is excessive, so for today's post I'm going to let others do the cursing for me.

I have no right to wag a finger at unprofessional behavior by doctors. I've been known to swear more than the average stand-up comic, with and at my patients at times. I've thrown any number of profanity-laced tantrums over the years, curse-word concerts that would make the screenwriters of Goodfellas blush. And I've written a book that landed me in hot water with so many (needless to say, now former) friends and coworkers that somebody shouting at me, "you'll never work in this town again!" is making an accurate statement, not a threat. I'm not proud of it, but I own up to it.

So when I read this making-the-rounds-on-Twitter story in the Toronto Star about doctors' misbehavior towards one another, over the ill-fated fee agreement from summer 2016, and the more recent "palace coup" directed at the OMA leadership, I decided to let more upstanding and honorable professionals point fingers where appropriate. As someone who's largely removed from it these days, however, I do feel comfortable discussing the systemic, cultural woes in the health care system.

The sad truth is that for all the claims in hospitals and health institutions about teamwork and patient-centered care, and all the time and education put into communication skills training, people in health care run on a steady diet of coffee and FEAR. Fear of disciplinary action, fear of a bad evaluation, fear of a blemish on an employment record, fear of a lackluster grade, fear of patient complaints, fear of income loss, fear of offending people, fear of bad press, fear of a lawsuit, fear of online trolls, fear of chastisement for a mistake, fear of job loss, fear of catching a disease, fear of injury...the list is endless. It's as if we're always waiting for the proverbial other shoe to drop over anything, and it creates little more than stress and awkwardness and anxiety, even in the most innocuous of interpersonal contacts.

I (not-so happily) recall my OB/Gyn rotation as a medical student. I found it insanely nerve-wracking, especially as a male, to meet a woman for the first time and within minutes, be expected to perform an invasive and uncomfortable exam, without a trace of the confidence a senior resident or attending might have. I guess my discomfort showed, because on my first or second night of call, one of the nurses took an immediate dislike to me for reasons to this day I remain unaware (my mouth was better governed in those days, so it wasn't my language). Even an attempt at speaking with her in private, to clear the air and apologize, blew up in my face, earning me a scolding from the Chief Resident and seeming inability to do anything right for over a month. My last two nights of call, I woke up early to preemptively round on the entire postpartum ward myself, in a desperate attempt to gain a shred of credibility. Was it any help come evaluation time? Nope.

I fared little better in my early months of residency. For some inexplicable reason, it's become accepted practice (and even a rite of passage) for newly-minted doctors to be thrown into stressful and exhausting nights on call from the word go, tending to patients barely clinging to life, often completely out of their depth. Need help from a senior? Handle it yourself, I'm busy. And the staff doc? Won't answer a page for hours.

It's a cycle that repeats time and again, giving altruistic and energetic trainees chips on their shoulders from the earliest days of their clinical careers. Like is often the case with victims of family violence, the abused grow up to be abusers in their own right, feeling entitled to the spoils of income and prestige, free of remorse for bullying their juniors. I went through worse back in my day.

I'll go out on a limb with an opinion here, and say that the idea of letting the College of Physicians take disciplinary action against these doctors for sending bullying e-mails and profane tweets is well-intended but counter-productive. First, the offending doctors have already been named and shamed in Ontario's (if not Canada's) most widely-read newspaper, which means their friends, family members, colleagues, and patients will have had more than enough time to confront them personally. Pariahs they might be, but sic the College's bullies on them, and they'll become martyrs, with reason to disrespect and despise the OMA even more than they already do. If not given a chance to own up to mistakes, professional sanction won't make much of a difference. If they're disinterested in acting professionally and showing remorse, the next transgression can be dealt with as a disciplinary issue. I have faith that most doctors are thoughtful people at their core...if we won't extend coworkers and colleagues the benefit of the doubt, what's the point in training and working in teams?

Obviously it will take leaders, in particularly those in a position of mentorship, to model courage in confronting bad behavior immediately, without resorting to the knee-jerk threat of documenting every little thing, nor adding fuel to the fire by counter-tweeting or counter-posting online.

More importantly, we need to put our money where our collective mouths are, and be willing to accept, acknowledge, and take responsibility for mistakes - in ourselves, our coworkers, and the system as a whole - without making mountains out of molehills and staying mindful that we're all on the same side.

Of course, this particular episode was no molehill. It was a collection of hateful displays by people expected to know better, and I would argue out of proportion to the rationales offered in defence. Sadly, and in the way life is rarely fair, those who are injured are the ones that will now be asked to show grace and forgive. They can't be blamed for being unwilling, but - patients included - we will all better off if they are.


  1. Frank,
    Everything you write goes well with me, right or wrong, it is your opinion, and you have a way with the pen.

  2. Good day Dr. Walsh. Great article. Med Post link does not direct us to your article but I found it anyway. With regards to the errant behaviour by the small number of extremely passionate physicians, their behaviour was inexcusable as it oversteps the boundaries of decency. However Dr. Walley subsequently seeking solace in the caring arms of the physician bashing Toronto Star (and she must surely know that the Star hates physicians!) confirms why she had to resign. Classic example of distraction from the real issue - her own questionable leadership over many months. A classy and better response which would have gained her some respect would have been to gently explain to the Toronto Star that she understands and appreciates the passion of her colleagues and she does not take it personally and so it is a non-issue. She could have when interviewed direct the journalists to focus on more important issues such as the Liberal government continuing to disrespect physicians (compare other unions e..g Elementary teachers contract). Instead, she behaves like a cry baby and gives the Star more fodder to doctor bash. Dr. Walley's response was a reflection of her leadership over her tenure - disappointing - and ironically because of her failure to reflect upon her own missteps, principally of repeatedly failing to listen to membership, resulted in raising the ire of those errant physicians to the point that they crossed the line. Dr. Walley is not blameless in this fiasco.

    1. Thanks for the comment! Nobody is ever blameless in these messes. That said, there's passion, there's unprofessionalism, and there's just plain rudeness.

      It really is incumbent on the profession as a whole to say, "you've crossed a line, and there's no excuse". Once you start qualifying things, you lose much more credibility with the media and the public because it's essentially blaming the victim.

      I had a woman post a rather scathing rebuttal to my piece on YouTube, which I'll probably link to in my next blog post. After a looooong reply, she eventually understood that my point wasn't to make excuses, but rather to find a way forward without the CPSO goon squad to go on another witch-hunt.

      If there's one thing I will never understand, it's why doctors are so thin skinned around these issues. Who cares what the Toronto Star says, good or bad? Most people will read the piece, say, "oh, some doctors called their president a c**t", shake their heads in disgust or bewilderment, and move on.