My blog is posted a bit late this month — I've been thinking a lot about respect and a few disrespectful events that recently came to my attention. Comedian Rodney Dangerfield made a career out joking that he “got no respect” – this was the theme of his stand-up routine as well as the topic of his two books, “I Don't Get No Respect” and “Its Not Easy Being Me”. But for lots of us, respect is not so much of a laughing matter. According to the 2019 Medscape physician survey, the #1 cause of burnout reported by pathologists is lack of respect from administrators, employers, colleagues, and staff. Fortunately, pathologists have one of the lowest rates of burnout – but this doesn't diminish our need for respect. Appreciation and respect were identified as areas of strategic need health systemwide in UCD's recent employee engagement survey. These are areas that we will be working on in our department and health systemwide.

Like Rodney Dangerfield, it's not easy being us. I sometimes joke that we are the department that everyone loves to hate (though I don't have a stand-up routine to go with this…). As pathologists and laboratorians, there are high expectations regarding our services – our work is in demand and central to patient care as well as to clinical research, so we are continually asked to push our limits and provide services that are faster, cheaper, more efficient, more precise, and sometimes not even available. Since others aren't very familiar with what we do, our limitations aren't always well understood. And because we don't have a patient-facing role like others, we are at risk of being treated like a servant to those who deliver direct patient care.

As a department chair, I've been trying to learn more about respect so that I can help our team get the respect we deserve. In a recent article in Harvard Business Review (HBR), Marquette University faculty member Kristie Rogers pointed out that two necessary types of respect are necessary in the workplace: 1) “earned respect” which is provided based on valued achievements or qualities, and 2) “owed respect” which is accorded equally to all.

A healthy work culture requires the right balance of owed and earned respect. It is my suspicion that too little owed respect forms the basis for the servant-like expectations that we pathologists and laboratorians sometimes suffer under. The academic environment we work in tends to skew toward earned respect since the faculty academic advancement process is based on individual achievement, such as grant awards and publications. Additionally, faculty salaries in many departments are dependent on individual wRVU production and dollars billed and collected, further emphasizing earned respect with little emphasis on teamwork or team spirit.

To mitigate disrespect, I think that there is a lot to be learned from the growing literature on microaggressions, i.e, the subtle but repetitive comments or actions, conducted consciously or unconsciously, that express a demeaning attitude toward a member of another, often marginalized, group. Microaggressions are best known as a form of prejudice toward under-represented racial, ethnic, or gender groups, but can occur anytime there is a perceived power difference, as can occur with senior faculty toward junior faculty, or in the attitude of some medical specialists who perceive themselves as superior toward another specialty or health care professional. In my observation, the disrespect that we experience toward pathology and laboratory medicine often takes this form.

So what can we all do to support a more respectful workplace and mitigate bias and microaggressions?

  • Say something: No one wants to pick a fight, but immediate feedback can make a big difference. The American Association of Child and Adolescent Psychiatry (AACAP) has a terrific on-line resource with lots of examples on how to respond in a safe and effective manner. These include asking clarifying questions “Can you explain what you mean by that?”, separating intent from impact “I know you may not realize this, but when you _(comment/behavior) ___ , it is hurtful/offensive because _____” and appealing to common values “I know you really care about ____. Acting in this way can really undermine _____.”
  • Use allies and influencers: If it doesn't feel right to respond right away, talk to a trusted colleague or supervisor. It is not uncommon for individuals experiencing a microaggression to question their experience. Discussion with others can help sort out the experience. Friends and allies can also serve as intermediaries and give feedback to the offender in circumstances where it isn't safe or appropriate for the subject to do so.
  • Be self-aware: To create a respectful environment, we should all pay attention to what we say and do. Disrespect frequently stems from unconscious bias – catching ourself in the act and apologizing can preserve important relationships and provides a meaningful example to others of humility and caring.

Lastly, we should be proud UC Davis is a leader in promoting a respectful community – we were the first university nationally to develop Principles of Community in 1990 which begins “We affirm the dignity inherent in all of us, and we strive to maintain a climate of equity and justice demonstrated by respect for one another.” In fact, this year, 2020, is the 30th anniversary of our Principles of Community. During this anniversary year, I hope everyone will show a little more love and respect to each other – including to all specialties.