I am beginning to despair that civility may be lost and gone forever. Civility—the art of respecting people you probably don’t know—is something that those of us of a certain age took for granted until quite recently, and I hope that a lot of people think it still exists. If it does, it’s time for a huge comeback.

The reason for this gloom is a spate of episodes I have either been involved with or have had reported to me. In most of these, a patient (or, commonly, a patient’s relative) has verbally abused or tormented a caregiver. If the context is one of a patient confronting a life-threatening or life-altering stress, there is room for some latitude and understanding. But if the context is simply one of a frustrated sense of entitlement—in other words, childish behavior on the part of an adult—then abuse of the caregiver is something that should not be tolerated. Caregivers (doctors or nurses) who give a sympathetic hearing to anyone in distress are following both their instincts and their training. But giving a sympathetic hearing is not a licence for abuse, and I regret that a sizable number of our patients think it is. We can only soak up a limited amount of hostility.

It may be a naïve thought, but I think that one means of limiting the decline of civility in society is to emphasize civility within the health care team. I have written here before (thank you, thank you, you are too kind) about the importance of nurses to the health and well-being of physicians as well as patients. They are more important now than ever. In the BMJ’s colloquium, “What is a Good Doctor?” a nurse correspondent pointed out that nurses don’t want to direct a patient’s management, and don’t envy the doctor’s responsibility, but they do want to feel that their input is valued and has been noted. I would have thought that this was obvious to all physicians, but there is still ample evidence that it is not. Shame on us, if that’s the case. If doctors demonstrably show respect for all members of the health care team, but especially nurses, then our less-civil patients may be more inclined to show mutual respect as well.

Medical misfortune is a great leveller, and we all want to maintain some sense of dignity when it happens. But medical misfortune should not be blamed on those closest at hand. A firm insistence on civility is the most efficient way for everyone, patient included, to keep their dignity. “Civility costs nothing and buys everything”—thank you, Lady Montagu. Keep up the good work.


Timothy C. Rowe, MBBS, FRCSC, FRCOG. Civility. BCMJ, Vol. 47, No. 1, January, February, 2005, Page(s) 6 - Editorials.

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