Crucial Skills®

A Blog by Crucial Learning

Crucial Conversations for Accountability

Dealing with an Abusive Physician

Kerry Patterson

Kerry Patterson is coauthor of four New York Times bestsellers, Change Anything, Crucial Conversations, Crucial Confrontations, and Influencer.


Crucial Confrontations

Q Dear Authors,

I was wondering if I could present you with a question. I have read your book and think it is great! I have used your suggestions and they have worked in just about every situation except one. I am a registered nurse with ten years of critical care experience. I also have a master’s degree and specialty certification. I feel that I am very knowledgeable and have saved a few physicians from disaster or inappropriate orders on several occasions. But one thing continues to bother me and I am not sure how to deal with it. What do I say or do when I have a physician act very sarcastic, rude, or insulting on the telephone?

It is rare, but lately I have had to deal with it on two separate occasions. I do let their supervising physicians know about the situation and how it made me feel, but I get the same excuses, “Oh they are just having a bad day,” or “They are tired and don’t really want to be on call; don’t take it personally.” What should I say other than I don’t appreciate being spoken to in that manner? It is a huge problem and the verbal abuse needs to stop. If their supervisors won’t deal with it what can I say to tactfully stand up for myself? Thanks in advance for any input you might have for me and the rest of the nursing community.

Trying to Be Tactful

A Dear Tactful,

Good for you for applying your crucial skills to tough problems in healthcare. Your patients, colleagues, and other healthcare professionals have all benefited from your willingness and ability to step up to high-stakes conversations. When it comes to dealing with abuse from a person in a position of power—and over the phone to boot—the challenge goes up because you’re now dealing with more subtle behaviors that you only hear and can’t see.

With phone conversations, tone, pacing, volume, and other factors take center stage while body language, facial expressions, and other visual elements no longer play a role. That means when you’re providing information to others about what happened, or giving feedback directly to the person, you have to take special care to point out the exact verbal elements that led you to the conclusions you reached. To you, the physicians’ words and tone communicated insult, abuse, and sarcasm, but you’ll have to explain exactly what they did if you expect them or others to act on your conclusion.

You said the physician’s supervisor tried to downplay the incident by suggesting that the person was having a bad day. My guess is that the supervisor is not feeling the full force of the abuse because you’re short-cutting the description of what took place. You might think that labeling the interaction as abusive or insulting would be enough to capture others’ attention, but you’re likely to get more of a reaction if you replay the interaction in detail.

Next time you’re poorly treated by someone and you choose to talk to the person’s supervisor, come with written and dated notes. Write down the exact words. For example, say you record the following:

“And then he said, ‘I figured that someone with your experience wouldn’t be such a bumbling idiot. Keep it up and I’ll have your head on a platter. Do you hear me? Keep it up and it’ll be your job!'”

When you read aloud the exact words of this clearly abusive interaction, it’s hard to simply dismiss the interaction as being trivial or to conclude that you were being far too sensitive.

Should you choose to talk directly to the offending party, the same rules apply. Start by sharing your detailed description of what took place along with how it came across to you. Allow the details to carry the weight of your argument. Nobody is going to defend his or her right (or for that matter, their subordinate’s right) to call you a bumbling idiot or to threaten to hand you your head on a platter.

Make sure you separate facts from conclusions. Start with the facts—the exact words, tone of voice, volume etc. Then tentatively share your conclusion. You’re beginning to think that the other person doesn’t care how it makes you feel, or worse still, that he or she is using harsh and insulting words to intimidate you. Let the person know that it makes you feel disrespected, and that you really want to have a working relationship where you both feel supported and able to talk through problems.

In any case, please continue to demand that you be treated with dignity and respect. Everyone deserves it no matter the circumstances—and the more people speak their minds, the more likely it is the word will get out in your organization that being upset never gives anyone permission to be insulting or abusive.

Good luck in the future,

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The ideas and insights expressed on Crucial Skills hail from five New York Times bestsellers.


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