Setting the cat among the pigeons…

Now this blog is not about cats at all, but the expression in the title is nonetheless apt.

There was an interesting op-ed piece in the NY Times recently that was written by a nurse.  She wrote it about how doctors can be very openly condescending to nurses, even in front of patients.  Of course, I was surprised.  I had left medicine off my list of male-dominated hierarchical organizations that too often provide hostile environments for women.  How could that be?

Well, in any case, she had some recommendations.  I translated them over to our discipline a few posts ago, but no one noticed.  So I thought I’d try it again.  It just might set the cat among the pigeon.

The original recommendations from  Theresa Brown, an oncology nurse who also writes for the NY Times:

What can be done to counter hospital bullying? For one thing, hospitals should adopt standards of professional behavior and apply them uniformly, from the housekeepers to nurses to the president of the hospital. And nurses and other employees need to know they can report incidents confidentially.

Offending parties, whether doctors or nurses, would be required to undergo civility training, and particularly intransigent doctors might even have their hospital privileges — that is, their right to admit patients —  revoked.

But to be truly effective, such change can’t be simply imposed bureaucratically. It has to start at the top. Because hospitals tend to be extremely hierarchical, even well-meaning doctors tend to respond much better to suggestions and criticisms from people they consider their equals or superiors. I’ve noticed that doctors otherwise prone to bullying will tend to become models of civility when other doctors are around.

In other words, alongside uniform, well-enforced rules, doctors themselves need to set a new tone in the hospital corridors, policing their colleagues and letting new doctors know what kind of behavior is expected of them.

My translation:

{We should look at] the question of whether leadership in academia could be more effective.  So far the APA has hardly been a help.  Perhaps we should try to energize deans or department chairs. 

Should we try a petition and a set of action guidelines to be sent around to chairs?  What sort of petition might stir things up?  What sort of guidelines could there be?  Should the guidelines come monthly, with perhaps different areas for different months?

I am thinking of the sort of petitions that we commonly mention here.  Could we get a lot of philosophers to sign a petition urging chairs and deans to address the gender inequality in the field?  Gender and racial?  And at least suggest the sort of things that can help.  I believe we could get a emailing list of at least US dept chairs from the APA.

6 thoughts on “Setting the cat among the pigeons…

  1. I worked in a hospital pharmacy for about 2 and 1/2 years, while in college, and spent a fair amount of time taking various things down to the floors. This remark about doctors and nurses does not surprise me at all- I regularly saw doctors yelling at nurses or otherwise humiliating them (and less often yelling over the phone at the pharmacists), even when the problem was either not the nurse’s fault, or was even the doctor’s fault. (My mother has been a nurse at the same hospital for 20+ years, and I’ve heard similar things from her.) Unfortunately, however, there didn’t seem to be an clear connection between the gender of the doctor and the tendency to yell- the worst two offenders I knew of were female doctors. Rather, it seemed a general power issue, and the fact that they knew they could get away with it.

  2. Matt, but it isn’t just power, is it? Presumably a lot of these people ‘kick down and kiss up.’ So they’re in positions where they can feel powerless, and that may be part of it. If that’s so, there’s something in the organization or its mode. I’m tempted to say that the nastiness resides first in the organization; that may be medieval speak.

  3. In many hospitals doctors don’t work directly for the hospital and are only loosely controlled by it, I think. (To some degree this has to do with malpractice insurance practices, but there are other reasons, too.) They are “associated” with the hospital, and I guess the hospital could un-associate with them, but at least with the doctors I saw most regularly, they did not have a direct boss above them in the way most people do. (This might be different with, say, emergency room doctors and perhaps others- I’m not sure.) So, I certainly didn’t get the feeling they were “kissing up and kicking down” so much as they just enjoyed abusing people below them and could get away with it, though I may be wrong. (Also, they did not want to think any problems could be their doing.) Something similar happens with law firms, with partners (who are not boss-less, in some sense, but also, at a certain level, are co-owners of a co-op and can be controlled by the other partners only very loosely) being notorious for screaming and yelling at junior associates, clerical help, etc. From both the hospital and law firms, the message I take away is “people with power often like to abuse it, for no good reason, and will often do so if they can”, and while it wouldn’t surprise me if this were, for several reasons, more true of men then women, it’s true often enough of women when they are in the right situation.

  4. Matt, your comment seems very sound. I’ll have to think some about it. It does argue for a fairly fundamental flaw in us, and that might be right. Somehow, though, it strikes me that there should be more of an institutional factor. Must think more…..

  5. Yikes! I just realized that Matt and I have gotten distracted from a major theme of the post: Should we try out a survey on gender and philosophy? And use it as a lobbying tool?

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