A doctor is expected to take responsibility for his or her behaviour. Occasionally there are incidents in the workplace which have repercussions within the team and have the potential to affect patients and colleagues. Often it is an individual's behaviour which is at the centre of an incident.
Data from the National Clinical Assessment Service (NCAS) suggest that behaviour in work is the leading concern across all medical specialties when referrals are made for further investigation by NCAS.
An incident may be a one-off, or a combination of several events, but it is how the incident is managed by the individuals concerned that determine the extent of the impact on others. It is therefore essential that the incident is effectively managed, often requiring immediate intervention as any delay can create further challenges.
By considering what behaviour is both acceptable and unacceptable in the workplace and by complying with employer policies and procedures, it is more likely that incidents can be resolved at an early stage and the healthcare team can then focus on working together for the benefit of the patient.
It is therefore in your interest to ensure that you have read and understood your employer's policies, in particular the 'Working Well Together' policy, or equivalent.
What is acceptable behaviour?
There are many things that everyone can do to ensure that the workplace is a professional, and pleasant, environment. For example:
- Always introduce yourself "Hello, my name is..."
- Say "please", "thank you"
- Offer to help
- Be co-operative
- Communicate your intentions - try not to assume that people know what is going on with you (it may be obvious to you, but not obvious to others)
- Recognise the contribution that other team members make
- Speak calmly and politely
- Take time to reflect on your actions, as well as those of your colleagues
- If you are simply having a bad day, be aware of it
- Think about what you say, and how you say it
- Ask for help when you need it
- Regularly reflect on your behaviours and ask yourself the question "did I treat everyone as I, or a member of my family would wish to be treated?"
What is unacceptable behaviour?
It is often difficult to recognise behaviours, comments and non-verbal responses that can cause offence to others, and are therefore unacceptable. A casual remark made over a cup of coffee, will be acceptable to some, but not to others.
So, if the behaviour described below occurs and interferes with your ability to work with others to the extent that the delivery of quality health care may be impeded, it is likely to be unacceptable.
- Jokes or non-clinical comments about race, ethnicity, gender, religion, sexual orientation, age, physical appearance, socio-economic or educational status
- Embarrassing others
- Humiliating or criticising colleagues or staff in front of patients, visitors or other staff
- Demeaning comments or intimidation
- Arguments with patients, family members, staff or other care providers
- Insensitive comments about the patient, for example medical condition, appearance, situation
- Outbursts of anger
- Profane, disrespectful, insulting, demeaning or abusive language
- Unwarranted negative comments about another doctor's care (orally or in chart notes)
- Behaviour that others would describe as bullying or harassment.
- Refusal to comply with known and generally accepted practice standards which then impede other team members from delivering quality care
- Use or threat of violence towards patients, family members or colleagues
- Repeated failure to respond to calls or requests for information
- Failure to pass on relevant information to colleagues
- Persistent lateness in responding to calls for assistance
- Difficulty working collaboratively or co-operatively with others
- Creating rigid or inflexible barriers to requests for assistance or co-operation
- Isolating others
- Allocation of irrelevant or inappropriate work
- Throwing or breaking things.
Behaviour is subjective, and what you do and say will be perceived differently by different colleagues. You should be aware that the behaviours outlined above may be perceived as bullying and harassment which is defined as 'persistent, offensive, abusive, intimidating, malicious or insulting behaviour, abuse of power or unfair penal sanctions, which makes the recipient feel upset, threatened, humiliated or vulnerable, which undermines their self-confidence and which may cause them to suffer stress'.
But I am under so much pressure
There are many factors that can contribute to unacceptable behaviour including short term personal circumstances, financial pressures, family issues and health issues.
Furthermore, because of increasing demands on health care services, many health care professionals face added pressure, stress and exhaustion through work, which has the potential to impact on how we behave.
There is help available and it is up to you to seek the relevant support by talking to someone within Human Resources, self-referring to your Occupational Health Department or contacting the BMA's Counselling and Doctor Advisor Service on 0330 123 1245.
How do I resolve a situation?
Due to actions of another colleague
Occasionally, a doctor may be involved in a workplace incident which has arisen because of either inappropriate actions by a colleague or by themselves. The BMA is available to offer advice to its members in any such situation through its first point of contact (FPC) service on 0300 123 1233.
If you have been caught up in an incident at work as a result of the actions of a colleague, there are a number of steps that you can follow to try to resolve the situation promptly. For example:
- Take a step back and take time to reflect on the incident - was it intentional or inadvertent? A one-off or part of a pattern?
- Try not to take it personally
- Discuss the issue with your line manager or Human Resources manager in confidence to seek guidance and input - follow their advice
- Try to resolve the issue informally yourself or ask a colleague to act on your behalf
- Be firm, not aggressive. Be positive and calm. Stick to the facts and describe what has happened and how the incident made you feel
- If the behaviour continues, keep your line manager informed and seek further advice from Human Resources
- Familiarise yourself with your employer's relevant policies and procedures
- Follow your employer's procedures if you decide to proceed with a formal complaint
- Keep a record of relevant information, for example memos, emails, meeting notes and, as evidence, also names of staff who may be witness to particular negative behaviours
- Seek advice from BMA at any time.
Due to your own actions
If it has been brought to your attention that you have upset a colleague or patient, even if inadvertently and without intent, it is suggested that you do the following in addition to the above steps:
- Apologise and seek to resolve the situation as soon as possible
- Try to understand why your actions have upset someone - see it from their perspective
- Seek to provide or obtain relevant information, support and advice as necessary
- Take steps to ensure that the incident is not repeated
- Seek advice from BMA at any time.
Contact a BMA adviser at bma.org.uk/support or phone 0300 123 1233
BMA Counselling and Doctor Advisor Service - available 24 hours a day, 7 days a week
Disruptive Physician Behaviour Initiative - College of Surgeons and Physicians, Ontario
Good Medical Practice - General Medical Council (GMC)
Maintaining High Professional Standards in the Modern HPSS - A framework for the handling of concerns about doctors and dentists in the HPSS, DHSSPS 2005, Northern Ireland
Doctors' Health Matters - The work of the Doctors for Doctors Unit in supporting doctors and promoting wellbeing within the profession (2007)