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PT and the Greater Good

When the Bullied Become the Bullies

Published May 17, 2011 12:29 PM by Dean Metz

Last week, my fellow blogger wrote a piece on the practice of rewarding someone for less than rewardable behaviour. She made clear and relevant points about lessons not learned such as consequences of actions, all things don't always turn out well and an inability to cope when situations go badly.

There is a huge movement in the UK to combat bullying and abusive behavior, not only among children but in the workplace as well. It has been identified that kids who are bullies tend to continue the practice in the work environment. On the surface, this seems to be a noble and worthwhile cause. We've all had patients who spoke inappropriately to us. I even had one patient throw a walker at me in the lobby of his Upper East Side apartment building because I dared correct him in public. (He was about to sit down in open space about three feet from where a chair actually was).

Like the desire to not make young people feel badly for being less than the best at everything they do and to prevent their discouragement and disappointment, this policy has gone too far and created Frankenstein's monster in the process.

The fear of being brought up on bullying or abuse charges is so great here that patients are afraid to speak out when care is substandard. I work with a nurse in the community whose father is in the local hospital. Since arriving there, he has developed three pressure ulcers, missed meals and medication, and has not gotten out of bed for two weeks. This nurse is afraid to speak out on behalf of her father due to fear of being labeled abusive or bullying of the staff. The consequences of which could be severe for her work.

Vulnerable people do need watchdogs to prevent them from being victimized. However, once those safeguards start to impact negatively on those they were designed to protect, maybe we need to rethink just how paternalistic we really want to be.

Addendum: I wrote this piece and then the New York Times ran this article: So too much paternalism is no good and not enough oversight is also no good, it appears. Where is the happy medium?



Glad to know I struck a chord with you! Thanks for your thoughtful response.

Cheers, Dean

Dean Metz May 18, 2011 5:50 PM

I haven't had a lot of time for reading or commenting lately, but this is a hot spot for me.  I've experienced bullying personally, I've seen it with my children, and I've been an advocate against it in the workplace.  I even wrote a three part series on it for a family magazine and adapted it for a medical magazine.  From my experience I agree with your government's premise:  kid bullies grow up to be adult bullies.  Worse, adult bullies raise their own kid bullies.  I'll apologize now for any rambling that's likely to take place.

Interestingly, I just got an with a quote from a physician that essentially calls any doctor (or nurse) unprofessional who cannot accept a patient pointing out the doctor's wardrobe is not in the patient's best interest.  More on that in a future blog.  

But my point is...there are medical PROFESSIONALS and there are healthcare PROVIDERS.  In a perfect world one person embodies both.  The doctor who made the remark above is proof that there are medical practitioners in positions of authority who are both.  The key is to have one of those people in a position to support co-workers when bullying occurs.  But that person has to be carefully selected.

The oncology nurse who write the article you linked to is right: people respond better to criticism and correction when approached by 1. people equal or superior to them in authority and 2. people they respect.  To get buy-in that person has to be a respected authority.  

Unfortunately, even with that respected authority, there will be people who cower to bullies.  Part of that is on the cowerer.  I've been in a position to stop bullying.  I exhibited that I "had their backs" by actively addressing situations when they arose.  Still, I had people who would not speak up.  In addition to instituting policy and administrators of policy, you have to teach life skills to those who lack the ability to stand up for themselves.  

Another important factor is to emphasize the real issue.  In this nurse's case, she needs to look beyond her own discomfort and act as her patient's advocate.  In this setting, it isn't about the nurse and her hurt feelings.  It is about the negative impact the doctor's comments have on patient care.  When addressed this way, the matter can be handled objectively.  She is being paid to be a patient advocate.  When she allows the doctor to undermine her authority with that patient, she isn't doing her job.  Her letter was passive aggressive.  She outlines well her interaction with the doctor.  Nowhere does she mention going to that doctor one on one and telling him she feels his remarks compromise patient care and asking him to cease.  That is the behavior that needs to be taught and encouraged.

The behavior identified as bullying in your co-worker's father's case is neglect.  They aren't doing what they are supposed to be doing and as a result they are receiving substandard care.  By that definition, the oncology nurse is bullying the patient because she is neglecting to do what she is supposed to do:  advocate for her patient.  So, the doctor bullies the nurse, the nurse bullies the patient.  The cycle is perpetuated, even when people don't realize they are doing it.

In your co-worker's case, it is totally different.  She is not a medical professional in that setting.  She is a family member.  Ideally, she would be able to move her father to a different facility.  And after enough patients did that it would raise awareness.  Unfortunately, too often this behavior is seen in facilities where the staff knows the patients and families have no choice.  Curiously the tables can turn in well-to-do facilities, or well-to-do wings.  Wealthy patients can become the bullies as they realize their upper hand with the staff (ie, money talks).  We usually don't call them bullies, though; they are simply demanding.  Like so many things in our society, the line of distinction has been lost when it should be drawn.

In all cases, to acheive a balance, it will have to start at the top.  The administration has to have a no tolerance attitude.  The employees have to know that the administration has their backs.  Healthcare providers and families have to be aware of, and confident, in an open door policy where concerns are voiced without fear of punishment.  Reporting suspected bullying should never be grounds for discipline of any kind.  

When the administration is sold out - on any matter - the environment changes dramatically.  In the case of government, in the UK or the US, I don't think it can qualify as "administration".  Just like the IRS, where no two people give you the same answer, the government has too many moving pieces for any person to feel like the government has their backs covered.  

A bullying program can not work without the people having confidence in the source.  I don't see how any government could successfully implement an anti-bullying program.  I'd love to be proved wrong.

Janey Goude May 18, 2011 2:46 AM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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