A Little Respect: Polarised Perspectives in the Emergency Department

A LITTLE RESPECT

The only assumption we, as healthcare professionals, should be making about one another in the workplace setting is that we are each aspiring to provide the very best care for our patients. Is mutual respect too much to ask for in the 21st century?

You may have already read this personal account of an Emergency Department interaction by @SLuckettG – if you haven’t, I strongly suggest you do so, since its contents have resonated internationally among women working in EM and other specialties. We’ve spoken before here at St Emlyn’s about the challenges of being a woman in EM and both accounts are familiar to me too – I am often described as scary or intimidating.

What prompted me to sit down at the keyboard was a false dichotomy emerging among women responding to the situation in the post above: the idea that women can either be nice (but fail to be assertive) or be “bitchy” in the workplace.

What is a “nice” doctor? And what is “bitchy”, in the context of a senior Emergency Department doctor? Neither definition over at Urban Dictionary is particularly appealing:

Nice: Used as a filler during a pause in conversation. Doesn’t necessarily mean something complimentary.

Bitchy: An adjective that’s supposed to be used to describe someone irritable, moody and whiny. Even if a person is not bitchy but rather, honest or blunt, a stupid person may use “bitchy” to describe that person.

I find this hard to reconcile with my own Emergency Department experiences; I certainly do not want to be “bitchy” in my workplace.

I try hard to be polite and respectful and to say please and thank you (and sometimes these things really do not come easily). The Emergency Department can be a very difficult place to work at times and the teamwork therein is one of my absolute favourite things about our specialty. I have been fortunate to have a similar experience in my current working environment, with role models like Geoff Healy passionately advocating that the Sydney HEMS teams work hard to win “hearts and minds” when we meet other healthcare teams in the prehospital or hospital environment.

Please don’t mistake me here – I do not believe the people responding to the article genuinely mean that they would prefer to be “bitchy” – articulating a complex viewpoint never quite comes across in the 140character world of Twitter and I do not mean to be disrespectful towards them – I think they mean to say that in the same situation they would prioritise patient care over their colleagues’ perceptions of them as people.

Of course they would. And you would too. But I find this difficult to read because in reality we just don’t have to make that decision. This is not about being “bitchy”. We need to stop characterising assertiveness as such and I think we need to stop calling women “bitchy”, full stop.

There is undoubtedly a tension in the perception of women as assertive characters (Sandy Simons has written eloquently about behavioural expectations around women over at EM News) and I can’t help but wonder whether acute specialties, with their relatively frequently-occurring emergency situations necessitating timely action, attract and to a degree select a particular subset of personalities who might find it easier to embody the role of one who Owns the Resus Room (to quote Cliff Reid). This doesn’t mean that we can’t be assertive AND nice and actually this simplification commits us to finding a solution within our own behaviours, perhaps, rather than challenging the preconceptions which drive these tensions in the first place.

Reductionist, polarised views of subsections of society (women, people of colour, those who express a particular sexual preference, people struggling with mental health issues, for example) are extremely unhelpful, not least because they generate narrow-minded assumption-based interpretations of the actions of anyone identified as being within those groups but also because they generate oversimplified solutions to the inherent inequalities between them. The fact remains that people are different. The assumption that any applicable adjective (female, straight, married, British, childless – so what?) generates a definition of a person to the exclusion of all others is wrong.

As far as I can see, the only possible answer to the situation S Luckett-G describes is the adoption of a level of mutual respect among healthcare professionals. If you haven’t watched Victoria Brazil at smaccGOLD talking about how tribes within medicine are divisive, please do that. The only assumption we, as healthcare professionals, should be making about one another in the workplace setting is that we are each aspiring to provide the very best care for our patients. If and when we inevitably disagree with one another about care-related decisions, that platform of shared purpose is the one from which our resolutions should spring forward, instead of looking for character, gender, preference or cultural traits to explain where the conflict came from.

If we buy into this concept it means we need to speak out against discrimination and inequality in all forms, including this hate crime experienced by Thom O’Neill:

But also this completely unhelpful response.

Screen Shot 2016-04-09 at 20.31.00

Is mutual respect too much to ask for in the 21st century?

Of course not. But it needs to come from all of us, whether you are experiencing it or not. Maybe then we’ll be able to look back and wonder why the hell we were making so much fuss about how gloriously, wonderfully, beautifully different we all are.

Nat

Before you go please don’t forget to…

10 Comments

  1. Sumit

    Dr. May, I commend you for the time you have taken to address this issue. I read the post you referred to, and also have been upset that women are pressured by society to feel that they must be one way or another, exclusively. I will be sure to emphasize teamwork and mutual respect in all my interactions, with patients, coworkers, and simply everyone around me. It’s just the right way to live. Thank you for sharing your views on the situation and emphasize that this applies to all situations where individuals are discriminated against.

    Reply
    1. Natalie May (Post author)

      Thanks Sumit! And you can call me Nat 🙂 http://stemlynsblog.org/whats-in-a-name-st-emlyns/

      Reply
      1. Sumit

        Nat! Will do!

        That piece is perfect for what I have been pondering myself recently. I prefer to go by Sumit, wherever I am. Not everyone agrees with me, but I think the article addresses the topic quite well. Thanks for sharing it!

  2. Sandra Viggers

    I love this post Nat! This is so important. I don’t want to be “bitchy” instead I try to be polite, decent, respectful and assertive and Vic’s talk about tribalism is one of those videos I frequently suggest people watch at least once to understand how I think about how we should act in healthcare…and life! Thanks for putting this one together.

    Reply
  3. Anand Swaminathan (@EMSwami)

    Excellent post, Nat on a really important topic. It is our role as educators and mentors to foster the proper attitude. I expect all my residents to have the same professional attitude but to also have the ability to control the room. I think the word “bitch” gets misapplied to people (mainly women) who are assertive and demonstrate the ability to take charge and lead. I hear the word slung around now as a complement at times as well but language matters and we need to make sure we are being heard clearly.
    Thanks again for continuing this discussion!

    Reply
    1. Kari Sampsel

      I totally agree (and what I meant in my tweet) – bitch is applied to women when assertive/commanding would be applied to men in the same situation. Being respectful is always the MO – but that is a 2 way street and it seems that much of that respect doesn’t flow back to the assertive female emerg doc!

      Reply
  4. Pingback: Global Intensive Care | A Little Respect: Polarised Perspectives in the Emergency Department

  5. SLuckettG

    Dr May!

    Thanks so much for so beautifully articulating what I have been struggling to explain to so many people who have responded to my post. In describing my experience with being called out as ‘bitchy’ in the department, I meant to say that the way we label the actions of assertive women is demeaning and oppressive, and not that we must choose to be ‘bitches’ or not in the department. In reading your response, I really think that you understood what I was trying to say.

    I have been fortunate to receive so much SoMe support since publishing my post, but I have spent a lot of time trying to explain to people who were understandably (and perhaps laudably) upset that the post is not about my attending calling me a bitch – she didn’t. It’s about how we characterise assertiveness and confidence in female trainees (and likely in female attendings as well) and how that often differs from how we characterise the same in my male colleagues.

    Reply
  6. drkirstyc

    Thanks for the thoughts Nat. A shame in some ways that it had to be written by a woman…..no, stick with me here!

    We as educators and mentors should model (and develop in our trainees of all genders) polite assertiveness. This will annoy some of our colleagues (in my experience, it is usually those who are feeling at the edge of their comfort zone). However the use of gender- (or colour, sexual preference or reproductive status) -specific derogatory comments should be perceived as THEIR problem, not ours. And challenged (politely, at the appropriate time) as would any other non-constructive behaviour.

    However we need to realise that the same leadership style does not work for all – there is more than one way to own a resus room, and we should enable our trainees to find the one that suits them.

    Thanks for making me think again,

    Kirsty (female, white, straight, married, parent, left-handed – none of which is relevant)

    Reply
  7. Pingback: LITFL Review 227 | LITFL: Life in the Fast Lane Medical Blog

Thanks so much for following. Viva la #FOAMed

Translate »