Dear Director,
There seems to be a lot of cursing in my ED by the staff. I’m no saint, but how much is too much? Do you ever think it’s OK?
Bleaped Out

Dear Bleaped,
In the back of my head, as I’m cursing, is my high school English teacher who said that cursing is for those with limited vocabularies and difficulty expressing themselves. In my view, the standards of acceptable speech have declined in the past 10-20 years, maybe due in part to the 1970s movie The Bad News Bears or more recently to cable television. However, workplace standards should not be compared to cable television standards. For your ED, answer a few questions:

Gauge the Problem
How bad is the cursing in your ED? I know of one residency that planted a tape recorder at the nurse’s station and heard everything from people discussing their sex lives to others dropping the F-bomb every few words. I’m not saying I’d want all the conversations in my office recorded, but think about it: If a recording taken in a public area of the ED would make your mother blush, you’ve got a problem worth addressing.

On Stage/Off Stage
I am a true believer in the Disney theory of on-stage and off-stage behaviors. We know that Mickey Mouse shouldn’t be smoking a cigarette in front of crowds in the Magic Kingdom, but we forget that when people come to the ED, we are often seen as the main event. As the “stars” of this show, an EP’s professionalism will invoke the trust of our patients and their families.

Picture this: you’re in the ED with a family member and you’re put into a room adjacent to the nurse’s station about a half hour before shift change. After 25 minutes of waiting you poke your head out the door and catch sight of a doctor walking up to the nurse’s station in his freshly starched white coat. But you’re smile quickly fades as you watch the doctor spend the five minutes before shift change telling tales of his weekend adventures to his co-workers, using curse words every 5 seconds. The professional appearance has been wrecked.

What Does the Lit Say?
Leave it to the cheeky Brits to publish a study showing the beneficial effects of swearing in the workplace. The 2007 report suggested that swearing – only in social conversation, never in front of customers and never in an abusive way – improves solidarity and creates a more pleasurable and productive place to work. But don’t go throwing the rules out the window just yet. In 2008, a survey on an online job search site for executives found that cursing in the workplace was considered the worst breach of all, and 38% of office managers reported firing employees due to foul language. Many discrimination lawsuits and violent acts at the workplace between employees involve or start with cursing and vulgar language.

When is Cursing OK?
Many would say that cursing is never OK, but let’s be honest, in our world it’s going to happen. Here is my personal opinion, and there are plenty who will take a less tolerant stance. I suggest limiting it to a few situations. I think everyone understands an occasional curse word when the shit hits the fan (think megacode scenario). There are even rare occasions when I will swear when talking to a patient. The patient is usually a young adult and it’s after they’ve cursed a good bit and I feel comfortable with them. It’s always limited and for emphasis, usually describing how they’ll feel a day or two after a car accident or if they have the flu. On the other hand, it’s never acceptable to curse at someone in a negative way or to describe someone. I once had an intoxicated patient throw his full urinal at me. I lost my cool and used some foul language. However, what I did not anticipate was how badly I would feel when I walked into the room next door to start caring for a nun. That’s right, a nun. I could only imagine what her perception of me was after just listening to scream profanities at my previous patient.

In the End
While swearing in the workplace might build some sense of camaraderie, in the public environment that we’re in, we should seriously limit or eliminate our cursing. Know your audience and apologize when you think you’ve crossed the line. Speak with your docs, reminding them that patients and staff need to see you as a professional who won’t lose their cool under pressure.     

Mike Silverman, MD is the chairman of emergency medicine at Harbor Hospital in Baltimore and is on the faculty at the TeamHealth Leadership Academy

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