It's Nurse vs. Doctor on the New York Times Op-Ed Page

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The pitfalls of airing personal grievances publicly, as Theresa Brown did against a University of Pittsburgh Medical Center physician this week

An oncology nurse penned a blistering op-ed in Sunday's New York Times venting against doctors for creating a culture of disrespect in hospitals. No doubt about it, there are curt and haughty doctors out there, behaving rudely to fellow physicians and nurses alike. The real news lies in the fact that in today's considerably more comfortable climate, even giants of general surgery with good reputations are brought low by a single ill-considered, vaguely misogynistic comment.

So in 2011 a New York Times op-ed blaming doctors for sparking negative hospital cultures is rather passé and makes you wonder what makes it worth running such a ho-hum opinion, especially on a Sunday.

What gives Theresa Brown's gripe its urgency is the way her established voice as a thoughtful Times contributor contrasts with her personal experience. Recently an asinine physician dressed her down in front of a patient:

It was morning rounds in the hospital and the entire medical team stood in the patient's room. A test result was late, and the patient, a friendly, middle-aged man, jokingly asked his doctor whom he should yell at.

Turning and pointing at the patient's nurse, the doctor replied, "If you want to scream at anyone, scream at her."

... I felt stunned and insulted.

The anecdote spices up the essay, driving home her bland, well-worn generalization about all those omnipresent, omniscient Doctor Deities. She reinforces our disdain with other pearls:

A nurse I know, attempting to clarify an order, was told, "When you have 'M.D.' after your name, then you can talk to me."

Point well taken (since at least the 1980s). What's concerning and ethically dubious about Brown's personal anecdote is its specificity.

It took me about two minutes of Google sleuthing to learn that the author and New York Times Well Blog contributor Theresa Brown practices on the oncology floor at UPMC Shadyside, despite the fact that she carefully keeps this detail off her personal website, her Times bio, and in today's op-ed.

She gives enough detail in the column that many people at her hospital, especially "the entire medical team" present at the time, will know precisely whom she's making an example out of. Using her platform at the Times, Brown just succeeded in royally bullying back the physician she's just publicly accused. The fact that his name doesn't appear in print? Meaningless.

University of Pennsylvania bioethicist Arthur Caplan, like me, was aghast this morning. Brown tells her readers she asked for the doctor's permission, whose quick quip back suggests he had no idea how slighted she actually felt by the comment or her intentions for its wide dissemination. Caplan tells me that consent in the heat of the moment "is not the same as asking later for permission to portray someone in a widely disseminated story where the person is put in a negative light."

"Retribution against workplace colleagues as a result of anger when it is easy to retrospectively identify who is who in a health care setting can adversely impact patient care," Caplan adds.

There's little question Nurse Brown just used the New York Times op-ed page to vent in a workplace spat. Politicians use the page that way, so why shouldn't doctors and nurses go at each other about their behavior last month, for our reading pleasure?

I'd never consider attacking on The Atlantic one of the physicians, nurses or therapists I work with, even if I was doing so as part of a broader lesson for the public good. Health writers like me and Nurse Brown should use our personal expertise and experiences to inform our commentary about the practice of medicine without adulterating our workplace relationships.

That's why you won't see Arthur Caplan, Director of the Center for Bioethics at Penn, saying much about Penn colleagues on MSNBC or any of his other platforms. "I try very hard not to succumb to the temptation to use cases from Penn and Children's Hospital of Philadelphia since I want my colleagues to trust me and be able to freely approach me for comment and feedback about difficult matters," Caplan says.

Kevin Pho, a New Hampshire internist who regularly contributes op-eds for USA Today, took to his popular blog KevinMD and his Twitter account to defend physicians against what he saw as an unfair full-scale assault on physicians. He refers to the piece as pandering to an anti-physician audience at the Well, the Times blog where Theresa Brown has been contributing for over two years.

Perhaps her workplace environment is particularly toxic, but the doctors I know harbor nothing but the greatest respect for nurses and the rest of the medical staff. They don't deserve to be painted with such broad strokes as was done here.

Brown's op-ed lays ultimate blame for inhospitable hospitals at the feet of physicians whose rap sheet even includes nurse-to-nurse bullying, a topic she's written about before. To Dr. Pho, Brown's tone is vicious and over-the-top.

Attacking physicians so personally only serves to drive a bigger wedge between doctors and nurses, when in fact, we need to be working together to solve this issue common to both professions.

Theresa Brown argues that MDs set the tone and that their behavior trickles down. That's true, and it's hard to see how anyone can feel good about working on the oncology floor at UPMC Shadyside when doctors are behaving the way Brown describes. Shaming one's colleagues draws attention Caplan says, but does little to cure the culture. As Caplan points out, hospitals are instituting courses about bullying, reporting systems are increasingly in place, and punishment is happening. "If you want to improve the culture then narratives have to be drawn carefully to protect personal and institutional anonymity," Caplan told me.

Drawing and quartering your coworkers in the Sunday New York Times might be run-of-the-mill for politicians. I'd like to see something better out of doctors and nurses.

I believe Theresa Brown's anecdote is true. I've seen such behavior myself even if I can't imagine committing it. That said I do have some sympathy for the doc she wrote about. That's no doubt because I'm a doctor, too, and I don't know how I'd feel about working with Theresa Brown if she's ready to turn around and head to her blog, Twitter, Facebook or the New York Times op-ed page if I were to step out of line in one comment one day. Who in medicine doesn't fear for something they say being taken the wrong way? I hope I'm safe so long as I'm not as callous as Dr. X, but does the Brown factor mean I can't frankly disagree with or question a nurse or another doctor, lest I risk seeing them Twittering away about our disagreement in a thinly veiled way?

It's this potential chilling effect that I fear as the unfortunate outcome of airing this episode at UPMC. Like Caplan, I'd never want to make colleagues at my hospital uncomfortable about working with me by earning a reputation as their own in-house Mike Wallace.

So it's in that sense that I'd like to see this doctor offer his excuses or, more likely, his apologies. Can he cite any conceivable mitigating factors for his behavior towards Brown that day a few months ago, so demeaning her in front of that patient? Is there any other side to the story? I doubt it, but I'll listen to what he has to say and report it. Maybe he'd simply like to offer an abject apology?

If you work at UPMC Shadyside and know who Brown wrote about, please ask him to get in touch with me. Sorry I can't offer space in the Sunday edition of the Times. I'm willing to grant anonymity, given these circumstances.
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Ford Vox, MD, is a physician, based in Atlanta, who specializes in caring for people with complex brain injuries. He has written for Newsweek, Slate, and the Los Angeles Times.

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