Physician incivility in the healthcare workplace

Behaviour categorized as “incivility” includes aggressive or dismissive language and actions or inactions that degrade working relationships

Prevalence varies and is likely underreported owing to non-standardized definitions and heterogeneous behaviours.¹ More than 75% of health care employees have witnessed uncivil behaviour from physicians,² and 31% of physicians report receiving weekly or daily rude, dismissive, or aggressive communication from other doctors.³ Residents report higher rates of incivility toward trainees who are younger than 30 years, shorter than 5′8″, junior trainees, females or non-native language speakers, or who belong to a nondominant ethnicity.¹

Habitual incivility from specific individuals is commonly reported, but situational triggers can increase uncivil behaviour

High workload, resource limitations, communication challenges, poor team cohesion, unfamiliarity with team members, and interdisciplinary interfaces were associated with increased incivility.² Physicians with consistent disruptive behaviours may have concurrent mental health challenges.⁴

Incivility by physicians is associated with poor patient outcomes, adverse effects on health care professionals, and high organizational costs

Disruptive behaviour diverts attention away from patient care, diminishes team collaboration, and is associated with medication errors, patient neglect, surgical complications, and death.⁵ Healthcare team members experiencing incivility have decreased well-being, increased burnout, higher rates of absenteeism, and premature departures.⁵

Accepting incivility as inevitable in a stressful environment or excusable in “high value” physicians perpetuates the behaviour

Learners exposed to incivility are more likely to exhibit it.¹ Successful interventions for disruptive physicians include individual coaching and therapy.⁴ Structured approaches to improve emotional intelligence, introspection, conflict resolution, leadership and mindfulness have led to positive behaviour changes in the clinical environment.⁴

Organizational leadership is essential in successfully preventing and addressing incivility

Leadership training, role modelling, wide dissemination of institutional definitions and policies for incivility, improved reporting mechanisms, and implementation of a fair, consistent, and rehabilitative approach to addressing these behaviours are recommended.⁶ A persistent pattern of remorseless incivility unresponsive to this approach may require escalation and potential disciplinary action.⁶

References

1. 1. 
   Abate LE, Greenberg L. Incivility in medical education: a scoping review. BMC Med Educ 2023;23:24.
2. 2. 
   Keller S, Yule S, Zagarese V, et al. Predictors and triggers of incivility within healthcare teams: a systematic review of the literature. BMJ Open 2020;10:e035471. doi: 10.1136/bmjopen-2019-035471.
3. 3. 
   Bradley V, Liddle S, Shaw R, et al. Sticks and stones: investigating rude, dismissive and aggressive communication between doctors. Clin Med (Lond) 2015;15:541–5.
4. 4. 
   Swiggart WH, Bills JL, Penberthy JK, et al. A professional development course improves unprofessional behavior. Jt Comm J Qual Patient Saf 2020;46:64–71.
5. 5. 
   Hicks S, Stavropoulou C. The effect of health care professional disruptive behavior on patient care: a systematic review. J Patient Saf 2022;18:138–43.
6. 6. 
   Pattani R, Ginsburg S, Mascarenhas Johnson A, et al. Organizational factors contributing to incivility at an academic medical center and systems-based solutions: a qualitative study. Acad Med 2018;93:1569–75.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.