The benefits of civility in medicine: Better teams, safer care and healthier workplaces

Creating a culture of respect in healthcare is about more than courtesy, it drives safety and patient care, which is why Dr. Colin McCartney, Chief of Anesthesiology and Pain Medicine at Sunnybrook Health Sciences Centre, has been leading initiatives to foster a kinder working environment.

Dr. McCartney shares his insights on civility in medicine, highlighting both its importance and practical steps for building a culture of respect:

Civility is the bedrock of a safe, trusting, and effective healthcare environment. Often dismissed as "soft skills," uncivil behavior — such as public criticism, eye-rolling, or hierarchical intimidation — carry significant costs, often undermining the psychological safety required for high-stakes medical teamwork.

What Causes Incivility: System Failures and The "Brilliant Jerk"

While high workloads and stress trigger bad behavior, systemic failures often sustain it. Medical culture frequently rewards clinical productivity over team climate, leading to the "brilliant jerk" phenomenon, where disruptive but high-volume physicians are protected. A "hidden curriculum" in medical education also implicitly teaches that humiliation is an acceptable pedagogical tool. These structures prioritize competence over kindness, ignoring that the two are inextricably linked.

What is the Impact on Safety

Exposure to rudeness hijacks cognitive bandwidth and hinders performance. In a simulated operative crisis, anesthetists performed at expected levels 91.2% of the time with a polite surgeon, but plummeted to 63.6% when exposed to a rude surgeon. This research, reported in BMJ Quality & Safety, highlights that Incivility is not merely an HR issue but a patient safety hazard that increases error rates and drives staff burnout.

How to Foster a Culture of Respect

Building civility requires intentional action at every level:

• Interpersonal Conduct: Adopt the rule of "public praise, private critique." Acknowledge contributions from all team members, such as nurses, residents, and students alike.
• Leadership: Model self-regulation. Invite perspectives by asking, "What might I be missing?" and redirect rudeness to protect the team.
• Crucial Conversations: Use established frameworks to navigate conflict. Focus on Mutual Purpose — the patient’s well-being — rather than winning the argument. Use the STATE path: Share facts, Tell your story, and Ask for the other person’s perspective.
• Tools: Use the "Knock it Out" framework” (pictured below) published by the AAGBI to address incivility at work.

We are all human, and workplace stress is inevitable. However, building a kinder working environment improves patient care and supports the team. Recognizing our impact and choosing respect is essential for creating better teams and safer care.