There is a horrible term in the nursing literature: horizontal violence. I prefer bullying. It happens.

In any system under stress it happens. One way to measure this is by questionnaires.

Horizontal Violence (HV) is malicious behavior perpetrated by healthcare workers against each other. These include bullying, verbal or physical threats, purposeful disruptive behavior, and other malicious behaviors. This pilot study investigates the prevalence of HV among Emergency Department (ED) attending physicians, residents, and mid-level providers (MLPs).

An electronic survey was sent to Emergency Medicine attending physicians (n=67), residents (n=25), and MLPs (n=24) in 3 unique EDs within a single multi-hospital medical system. The survey consisted of 18 questions that asked participants to indicate with what frequency (never, once, a few times, monthly, weekly, or daily) they have witnessed or experienced a particular behavior in the previous 12 months. Seven additional questions aimed to elicit the impact of HV on the participant, the work environment, or the patient care.

Of the 122 survey invitations, 91 were completed yielding a response rate of 74.6%. Of the respondents 64.8% were male and 35.2% were female. Attending physicians represented 41.8%, residents 37.4%, and MLPs 19.8% of respondents. Prevalence of reported behaviors ranged from 1.1% (Q18: physical assault) to 34.1% (Q4: been shouted at). Fourteen of these behaviors were most prevalent in the attending cohort, 6 were most prevalent in the MLP cohort, and 3 of the behaviors were most prevalent in the resident cohort.

The horizontal violence behaviors investigated in this pilot study were similar to data previously published in nursing cohorts. Furthermore, nearly a quarter of participants (22.2%) indicated that HV has affected care for their patients, suggesting further studies are warranted to assess prevalence and the impact HV has on staff and patients.

I am unsurprised. The rates among physicians are similar to nurses. Moreover, there are no tested interventions to limit such: it is a consequence of an overstretched system in part… and trying to do the best for the person in front of you. Pathologizisng all rudeness and disagreement may be counterproductive.