Swearing is commonplace in society, but is it acceptable for doctors to use expletives when at work? Marika Davies looks at the issues People swear every day and doctors are no exception. Expletives are often used by those working under pressure, and the use of informal language can help to build relationships with patients. But swearing by doctors could affect colleagues and even damage relationships with patients. The prevalence of doctors swearing at work is hard to pin down. In 1999, The BMJ published a study looking at how often surgeons swore in the operating theatre. By assigning points to swear words to reflect their strength and by monitoring the frequency of their use, the researchers found that surgeons on average registered one swear point for every 51.4 minutes they were operating. The rate of swearing differed by specialty, with orthopaedic surgeons swearing most often, registering one swear point every 29 minutes. Beyond these findings, there are few data on how common swearing is among doctors. The General Medical Council (GMC) does not record specific data on complaints about swearing. In 2013 it considered 13 complaints relating to allegations that a doctor had verbally abused a patient and a further 184 complaints relating to doctors being rude to patients. The media show particular interest in the cases of doctors who appear before GMC fitness to practise panels facing allegations involving swearing. In May 2013 a surgeon carrying out a laparoscopic appendectomy lost his temper, shouted, and swore at colleagues; threw a piece of equipment; and had to be ordered to leave the operating theatre. After further concerns were raised about his behaviour, he was referred to the GMC and suspended from the medical register for 12 months. In another incident in 2009 a surgeon shouted, “This is shit” when told that a procedure would take up to three hours. He was erased from the medical register in February 2012 after an investigation into allegations of unprofessional behaviour. The fitness to practise panel said, “We are of the view that [his] actions had the potential to damage public confidence in the medical profession. Such behaviour is wholly unacceptable.” When BMJ Careers asked doctors on Twitter whether it was acceptable for doctors to swear, some said it was, in certain situations. Ollie Minton, a consultant in palliative medicine research, pointed out that many doctors do swear at work. “It depends on the patient and the relationship—many will use ‘fruity’ language routinely,” he said. Keith Grimes, a general practitioner (GP), also said he swore in front of patients. “I swear fairly frequently, when appropriate,” he said. “It varies by situation, patient, and history.” Relationships Doctors also said that swearing can help to build relationships with patients. Max Davie, a paediatrician, said that when he worked with hard to reach adolescents, “the odd well-placed swear can be rather humanising.” Simon Curtis, a GP, has a similar view. “Always adopt the language of the patient, so definitely yes,” he said. “But in context and patient has to swear first.” Vicky Hewitt, a specialist palliative physician, said that she was required to swear as part of her job. “As an Army doctor I got pulled up for not swearing,” she said. “Some of my patients didn’t understand the term ‘passing water.’” Other doctors said that they would never swear at work and that they find it unacceptable when others do. Joseph Machta, a foundation year 1 doctor, said, “I have sworn but never near a patient. I hate myself for it too.” Ahmed Rashid, an academic clinical fellow, believes that swearing is “never acceptable in front of patients or their relatives.” He said, “It is as bad as a teacher swearing in front of their pupils. In fact, worse.” One reason doctors swear at work could be their high pressure working environment. Writing in the journal Psychosomatics, Daniel Zimmerman and Theodore Stern say that doctors often use offensive language which “can be used as a psychological tool” and “provide a channel of catharsis for aggressive drives and affects.” Risks to doctors who swear For those working under pressure the use of swearwords can be a useful form of release, but swearing in front of colleagues may also be considered unacceptable behaviour. For instance, foul language is included in the BMA’s definition of harassment, and the GMC’s Good Medical Practice says that doctors “must be polite and considerate.” Timothy Jay, a psychologist, says that doctors’ swearing could have a detrimental effect on lower ranking colleagues. “The authority to swear is a matter of power within a hierarchy,” he told BMJ Careers. “Doctors swear at nurses, but nurses do not swear at doctors. Patients and their families swear at nurses but less so at doctors. This is one reason why so many nurses leave their jobs.” Pallavi Bradshaw, a medicolegal adviser at the Medical Protection Society, says that doctors are obliged to treat their patients with respect. “Swearing on the job would be seen as contrary to those obligations. Employers, the GMC, and most importantly the public, take a dim view of doctors who swear at patients or colleagues.” Caroline Fryar, head of advisory services at the Medical Defence Union, says that swearing can “make a doctor appear unprofessional and is best avoided.” Medical royal colleges have also issued guidance to their members on professional behaviour, including the need to act professionally when communicating. Clare Marx, president of the Royal College of Surgeons, says that the college has recently launched Good Surgical Practice, which sets out the standards expected of all surgeons.“It states that surgeons should be mindful that their behaviour serves as a role model to junior doctors and they should set an example to other colleagues in their team by behaving professionally,” she says. “It also makes clear that they should communicate respectfully with colleagues and refrain from dismissive or intimidating behaviour and inappropriate, offensive or pejorative language, including swearing.” Richard Vautrey, deputy chair of the BMA’s general practitioners committee, says it is important for doctors to act professionally in all encounters with patients. “That means taking care to talk appropriately and in language that is not going to cause offence or be misunderstood,” he says. “I’ve not heard a doctor swearing in front of patients and wouldn’t expect to, no matter how difficult the situation.” Experiences of doctors swearing Between 2007 and 2013 researchers from Cardiff University and the University of Dundee asked medical students from across the United Kingdom to describe their most memorable professional dilemmas. The narratives they collected included a number of accounts of doctors swearing—for example, surgeons swearing in theatre. Students were not overly concerned about these situations, but they said that the atmosphere was “less professional” when this happened. Swearing was reported most often as part of wider abuse towards students and other staff, but the students occasionally reported that doctors swore about a patient, potentially within earshot of them. Here are some of the examples students gave. “Behind the patient’s back he did a very rude gesture . . . he did that [wanker hand gesture] meaning the patient and I felt that is the most horrendous thing . . . he was swearing about the patient as the patient was outside the room —but the door was just closing so the patient heard him. . . he said ‘that patient can ‘F’ off’ and we were like ‘what?’ we were totally gobsmacked”—Year 2 female “Had an orthopaedic surgeon throw his toys out of the pram once . . . it was literally just over one knife that they [the nurses] couldn’t find, so he just knocked something over and shouted, “Why haven’t you got it? This is an effing theatre.”—Year 2 female “The neurosurgeon didn’t introduce himself, swore when asked to [introduce himself] by the nurse, then shouted and swore abuse at the staff, unconscious patient and students . . . he was unprofessional and should not be practising”—Year 2 male “There needs to be a course for consultants called ‘curb the inner monologue’ because nobody seems to have told them that it’s not appropriate to just say exactly what you are thinking—for example, when they talk to a group of students and just start swearing . . . I worry about a doctor who doesn’t know when and where not to curse. It seems unprofessional, and it makes me uncomfortable”—Year 1 female “Watching a consultant shout and swear loudly in the middle of the ward at one of his juniors . . . [he] shouted loudly along the lines of, ‘For fuck’s sake, why the bloody hell did you do that?’ . . . I genuinely wished I had the confidence to stand up to him”—Year 4 male Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare the following interests: I am employed as a medicolegal adviser by the Medical Protection Society. Source
