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Question: A doctor I work with feels I am "too proud" and independent in my work. He dislikes my personality, and that's ok--we don't have to be buddies. But he has taken to telling each new group of residents that there is no point discussing anything with me because I am overbearing. He tells them they should just avoid discussion and agree with me. When I present an assessment in rounds he covers his eyes and bows his head. After he leaves, if I need to speak to one of the residents about a patient having problems, I can see them bracing themselves as I approach or rolling their eyes even though we may have never yet spoken to each other! I am viewed as a competant and compassionate doctor by families and co-workers, but this treatment is distracting and disheartening. It is making it difficult to provide safe care, to the point that I have considered leaving my practice.

Response: Even if this situation isn't the same as what other readers might experience, I think it can be a good learning exercise to think more creatively about how to respond to passive-aggressive (PA) behavior. Sometimes people are too focused on their own hurt, anger, and resentment that they don't look at other possible solutions. As I've indicated numerous times, normal communication and problem-solving skills don't work with PA people. Therefore, you need to be more creative in the solutions. Sometimes this might mean you need to step outside your comfort zone and engage in a different way.

The doctor is employing classic back-stabbing passive-aggressive behavior. He rallies each new group of residents to his side by gossiping about his colleague and turning them against her. He then reinforces his prior statements with his nonverbal gestures of covering his eyes and bowing his head. Back-stabbing PA behavior is one of the more difficult PA situations to manage because most attempts to confront the behavior would lead to more of the same. If confronted, the doctor is rewarded for his behavior because he knows that he is successfully distressing his colleague while being favored by the residents. Most likely this is some sort of ego booster for him often used by less competent people to discredit those who are more competent.

Although there is a way to probably stop his PA behavior during rounds, it takes a high level of skill that most people don't have and it will not stop his talking behind her back. For instance, when he engages in the PA nonverbal behaviors, she could very sweetly say, "Doctor, when you cover your eyes and bow your head like that it makes me think you disagree--what do you think of my assessment?" However, this needs to be delivered with just the right tone and facial expression of innocence (without any hint of sarcasm) so it is difficult for many people to pull off. It can be an effective way, though, to get him to stop the nonverbals. And at the same time it makes her appear more open to discussion which refutes his private insinuations to the residents. At first he is likely to bluster that she is misinterpreting but if she calls him out every time he is likely to stop.

However, as I said, that is difficult to pull off. In this case, it may be necessary to get to the residents before he does. The good thing about this scenario is that his behavior is predictable and residents rotate in and out. Therefore, his behavior doesn't poison her relationships permanently because those residents will be gone. If she can focus on developing a good first impression with the residents when they first arrive then his back-stabbing will be less effective. Yes, this will take more effort and may be uncomfortable if it is not consistent with her personality style. But I don't think it is more effort or more uncomfortable than having to leave a successful practice. So what she can do is before the residents come on rotation she can meet with them individually or as a group for an informal welcome. For instance, she could take them to lunch and let them get to know her in an informal setting. In this way, she prevents their only impression of her being the other doctor's gossip. They are less likely to take his comments to heart as his statements are not consistent with their impression of her.

If she does this, she doesn't have to address anything with them about the other doctor but just have an enjoyable lunch. However, if she would like to counter-act his statements even more she could say something like: "I know I can get quite intense during rounds because I am so passionate about this work, but don't let that bother you. I still welcome other opinions so feel free to let me know what you think." A statement like this establishes a working relationship with the residents and negates his back-stabbing. In fact, the combination of these suggestions could make him look like a jerk without her ever saying a word about him!

I suspect there also may be some irrational cognitions in this situation due to her statement about providing safe care and considering leaving her practice. So I have also written a Cognitive Diary Training Example based on this situation.