Author's note: This column is intended for educational purposes only. It aims to highlight gaps in health knowledge, provide support and empower organizations to guide their members in creating effective health and wellness programs.

In health care, as in other areas of life, the difference between respectful dialogue and incivility can mean the difference between clarity and confusion, teamwork and disunity, safety and harm. Frustration is evident on both sides of health care — between those providing care and those on the receiving end. Civility is not about avoiding hard conversations or suppressing legitimate concerns. It is about how concerns are expressed.

Advocating for oneself, as a patient, family member or clinician, should not require hostility or passivity to be heard.

When civility breaks down in health care, it becomes a patient safety issue.

Tension in health care is real — but it should never put patients or clinicians at risk. Burnout, staffing shortages, political polarization and moral distress are reshaping health care culture, but stress does not excuse intimidation or ideological hostility. Patients complain that they feel rushed, ignored, have unanswered questions or feel subtly judged. People should not feel afraid to ask questions, disclose symptoms or seek care for fear of incivility. This is not quality health care and the public should not normalize it.

A key truth: Patients are entitled to feel safe, respected and to receive professional, competent health care — regardless of views. Civility is an evidence-based driver of patient safety and staff well-being, defined by respectful, supportive and collaborative behaviors — beyond mere politeness.

PATIENT BILL OF RIGHTS

All patients have the right to:

• Respect and dignity (treated with courtesy — consideration for your personal, cultural and spiritual values)

• Information and communication (ask questions and receive clear, understandable information about your condition, treatment options — risks and benefits)
• Privacy and confidentiality
• Informed consent (give or refuse consent to any treatment or procedure)
• Treatment and care (receive continuous, high-quality, safe, professional care)
• Grievances (complaints and concerns addressed)
• Access to records

Consider taking an advocate with you any time you need to navigate the health care system, especially if you are elderly, have multiple comorbidities, are in pain, distress or are experiencing fear or confusion. An advocate can take notes, help you ask clarifying questions, de-escalate tense interactions and ensure your patient rights are adhered to. Learn to recognize and speak up about any unsafe or disrespectful interactions. Use calm, assertive communication — language that sets boundaries. Report any concerns to the charge nurse, supervisor, patient advocate or risk management immediately. Document details (names, date, time) of interaction and avoid inflammatory statements. Civility is not weakness — it is the foundation for safe health care.

WHY “HEALTH CARE” NEEDS CIVILITY AS PART OF ITS CULTURE

Civility is an essential component of a high-performance organization. In health care, civility benefits patients directly. When interactions are respectful, patients are more likely to share concerns, ask questions and adhere to care plans. Key impacts of civility include:

• Enhanced patient safety

• Reduced staff burnout and turnover
• Better team performance — better patient outcomes
• Improved patient experience

Become aware of and report these examples of incivility:

• Behavioral issues (belittling comments, eye-rolling, impatience, condescending language)

• Professional disruptions (skipping greetings, being unavailable or unresponsive to questions)
• Hostile actions (throwing items, hitting, spitting, kicking)

Incivility leads to poor outcomes and higher staff turnover. When nurses leave the profession, wait times grow longer, staffing gaps widen and stress levels rise — fueling a cycle that harms both patients and providers. To address this issue and as an early intervention, health care providers should establish a protocol where incivility can be reported by anyone (staff or patient) without fear of reprisal. Implement clear codes of conduct for employees, patients and visitors and post it clearly. Ensure that disruptive behaviors are not tolerated and are dealt with in a timely manner.

NURSING — STILL MOST TRUSTWORTHY PROFESSION?

Nursing has long been recognized as the most trusted profession in America, grounded in ethics, compassion and patient advocacy. Yet recent headlines tell a troubling story of rising hostility and unprofessional conduct toward individuals with different views, threatening a loss of public trust. There have always been a few, but rare, instances when a nurse caused intentional harm to a patient, ranging from infants in the NICU to the elderly and dying. Unfortunately, a few nurses see patients as ideologies instead of human beings in need of health care. Nursing’s ethical foundation requires care without judgment. When nurses begin to view the public as adversaries rather than people in need of care, something fundamental has shifted. While this posture may feel justified, it undermines the profession’s moral authority and damages the nurse-patient relationship, which signals a profession under duress rather than one operating from strength. These incidents aren’t just “bad behavior” but reflect systemic issues.

This trend should concern all health care leaders, whether in education, hospitals or nursing organizations such as the American Nurses Association, which should be a voice of restraint. The ANA’s Nursing Code of Ethics clearly states in Provision 1 (and throughout the other nine provisions), “The nurse practices with compassion and respect for the inherent dignity, worth and unique attributes of every person.”

FAITH AND CIVIC ORGANIZATIONS

Faith and civic organizations foster civility in health care by acting as trusted intermediaries that bridge gaps between providers and communities. They promote respect, health literacy and empathy while enhancing patient-centered care through:

• Role modeling
• Building trust and reducing disparities

• Cultivating compassion and support
• Providing practical assistance
• Advocacy

These contributions help shift the focus from treating illness to a more comprehensive model of community health and wellness with an increased awareness of civility.

Civility is not a soft concept of manners or politeness. It is a foundational element of patient safety and humane care. How we speak to one another — especially when tensions are high — shapes the health of our communities more than we realize.

Dr. Cheryl Christy is a Baldwin County resident and registered nurse with nearly 30 years of experience. She holds master's degrees in nursing education and nursing practice and a doctorate in nursing practice. She is a member of Sigma Theta Tau, Phi Pi Chapter, a certified lay counselor and the author of "Voices for Healthcare," a health care blog.

Read last week's column titled "Why health literacy may be the missing link to good health" on www.GulfCoastMedia.com.