The impact of civility on physician wellbeing

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Civility—or basic behavioural codes—has a strong impact on peoples’ wellbeing. Incivility in medical environments negatively affects clinical outcomes. And this is not to be treated lightly: any behaviour that impairs a healthcare team’s ability to function well creates risk. That was one of the messages award-winning physician and author Dr. Jillian Horton gave at her recent keynote to VPSA members on fostering a culture of wellbeing.

“My talk was about what physicians as individuals can do about work culture, relationality and wellness—where we each have agency,” said Dr. Horton. “My hope is that participants came away with an understanding of the cognitive traps in medical environments that can lead us to behave in conditioned ways that are uncivil as well as providing some simple strategies to use for fostering civility.”

Cognitive traps

“How can we work alongside one other and have such different opinions about whether or not we have an actual problem?” asked Dr. Horton. “It’s related to opinion and dogma; there’s a tendency towards high polarity in medical discourse. We often believe that our opinions are facts that are incontrovertibly true.”

Experiences of behaviour that is rude, dismissive, or aggressive differs based on several factors including age, gender, systemic racism and discrimination, the influence of naysayers, and different values. The effect of perceived rudeness is profound: it leads those affected to make more mistakes both immediately and throughout their day.

“We have to look at the qualities of our social environment that shape the ways we work together,” added Dr. Horton. “There are many positive reasons for working on those relationships and they help mitigate burnout. There’s a lot of connection between a culture of wellness and having job satisfaction, meaning, purpose, and resilience.”

Impacts of disruptive behaviour

Disruptive behaviour is a pattern of personality traits that interferes with a physician’s effective clinical performance and negatively affects the people with whom the physician interacts. These impacts include:

  • More medical errors
  • Lowered staff morale
  • Increased staff turnover
  • Undermined team effectiveness
  • Patient dissatisfaction
  • Negative reputation of cohort

“Disruptive behaviour has really pervasive impacts and we do not address it frequently enough in medicine,” said Dr. Horton. “Physicians set the tone in the environments in which we work. Psychological safety represents the idea that we will not be belittled, mistreated, humiliated or shamed when we ask a question and participate in our environment. Medical teams that feel psychologically safe make fewer errors.”

Cognitive errors that fuel incivility

  • The curse of knowledge – makes you think others aren’t pulling their weight.
  • Objectivity illusion – a failure to recognize your perceptions are biased.
  • Self-serving bias – attributing your own actions to situational demands but other’s actions to personal dispositions.

“Cognitive errors underlie some of our worst behaviours in a clinical environment,” said Dr. Horton. “We’re all guilty of them so it’s important to look inward as well as outward.”

Strategies for fostering civility

Dr. Horton concluded her talk by discussing three simple exercises she finds useful for influencing behaviour in pro-social ways:

  • Changing places – asking team members to consider what others find difficult in their work allows them to see things in a different way.
  • Rant and reframe – invite team members to pair off and take turns ranting for a minute about something they find irritating in their work. Afterwards, the team reassembles, and the other person reframes their partner’s rant in terms of something that person feels passionate about.
  • What else could it be? – asking this question allows you to look at things with an open mind and mitigates our self-serving bias.

Dr. Horton’s talk is available online until December 23. Check it out to learn more about creating the work culture you aspire to.

VPSA and physician wellness

Since VPSA’s inception in 2017, supporting the wellbeing of our members has always been a priority. Through our Community Building and Wellness Task Group and the VA/VC Physician Wellness Steering Committee, the organization continues to seek ways to improve the wellness of members. If you are interested in being involved with supporting this work, please let us know.

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