Sticks and stones: investigating rude, dismissive and aggressive communication between doctors

Editor – Bradley and colleagues make an important contribution to understanding the cultural issues that underpin patient safety in the NHS by describing the problem of rude, dismissive and aggressive (RDA) communication between doctors.¹ I would like to emphasise that this problem is not just confined to communications within hospitals but also across the primary–secondary care interface. As a general practitioner (GP) I have encountered RDA communication when trying to discuss patients with on-call hospital doctors. Often the tone of the conversation is patronising and not focused on solutions but speciality bashing and trying to deflect admissions. This has a pernicious effect on morale and can affect the future behaviours of GPs who could be put off discussing difficult patients with certain specialities (‘avoidant behaviour’ as described in the paper) with a potential to affect patient safety.

I welcome recognition of this issue and attempts to define and codify it through research. I am sure this phenomenon occurs in other settings of care. As more and more interfaces are established between primary, community and hospital care, interactions between clinicians from different disciplines will become more common to support integrated care. To achieve a truly excellent patient-centred service, all clinicians must be aware of the issue of RDA communication and the destructive effect this can have on patient safety. The requirement for proper standards of professional communications must be emphasised to all doctors.