title: Sticks and stones: investigating rude, dismissive and aggressive communication between doctors.
abstract: Destructive communication is a problem within the NHS; however previous research has focused on bullying. Rude, dismissive and aggressive (RDA) communication between doctors is a more widespread problem and underinvestigated. We conducted a mixed method study combining a survey and focus groups to describe the extent of RDA communication between doctors, its context and subsequent impact. In total, 606 doctors were surveyed across three teaching hospitals in England. Two structured focus groups were held with doctors at one teaching hospital. 31% of doctors described being subject to RDA communication multiple times per week or more often, with junior and registrar doctors affected twice as often as consultants. Rudeness was more commonly experienced from specific specialties: radiology, general surgery, neurosurgery and cardiology. 40% of respondents described that RDA moderately or severely affected their working day. The context for RDA communication was described in five themes: workload, lack of support, patient safety, hierarchy and culture. Impact of RDA communication was described as personal, including emotional distress and substance abuse, and professional, including demotivation. RDA communication between doctors is a widespread and damaging behaviour, occurring in contexts common in healthcare. Recognition of the impact on doctors and potentially patients is key to change.
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Bradley
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Samuel
authors.initials: S
authors.lastname: Liddle
authors.affiliation: Oxford Deanery, Oxford, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Shaw
authors.affiliation: South West London Deanery, London, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Savage
authors.affiliation: South West London Deanery, London, UK.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rabbitts
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Corinne
authors.initials: C
authors.lastname: Trim
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Tunji A
authors.initials: TA
authors.lastname: Lasoye
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK benjamin.whitelaw@nhs.net.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Whitelaw
mesh_terms: D000374:Aggression; D001291:Attitude of Health Personnel; D003142:Communication; D004739:England; D005260:Female; D017144:Focus Groups; D006784:Hospitals, Teaching; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D009341:Negativism; D015279:Organizational Culture; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data*
keywords: Medical education; communication; incivility; rudeness