Civil discourse as a leadership competency: the case for curiosity in medicine

Medicine runs on high stakes and higher emotions. People are tired. The work is complex. The margins are thin. And when the pressure rises, the first thing to break is often the thing we pretend is “soft”: how we talk to each other.

Civil discourse isn’t about being “nice” for the sake of niceness. It’s about being clear, respectful, and effectiveespecially when you disagree, especially when the pager won’t stop screaming, and especially when the patient in the bed can’t afford your team to be in a passive-aggressive cold war.

The leadership twist is this: civil discourse is a skill, not a personality trait. And the fastest way to strengthen it in clinical environments is to treat curiosity like a core clinical toolright up there with a stethoscope, a checklist, and the ability to say “I was wrong” without bursting into flames.

What “civil discourse” means in a medical setting (and what it doesn’t)

It is:

• Respectful disagreement without personal attacks
• Clear communication that prioritizes patient safety over ego safety
• Active listening that aims to understand, not just reload
• Accountability that corrects behavior without humiliating people

It is not:

• Conflict avoidance (silence is not harmony)
• Performative politeness while sabotage simmers underneath
• “Be nice to the loudest person” (that’s not civility; that’s compliance)
• A tone police operation that ignores real harm and power dynamics

If your team can disagree vigorously and still treat each other like professionals, you’re building what many safety leaders call a culture of safety: a place where people can speak up, learn, and improve without fear.

Why this is a leadership competency (not a “communication workshop” box-check)

Leadership in medicine isn’t only about decisions. It’s about the conditions that make good decisions possible. Clinical teams rely on fast handoffs, rapid escalation, and honest feedback. When discourse degradeseye rolls, sarcasm, intimidation, dismissive languagepeople stop speaking up. The result isn’t just a bad vibe. It’s risk.

In fact, major safety organizations have long warned that intimidating or disruptive behaviors can contribute to errors, reduce teamwork, and harm outcomes. That’s the key leadership link: behavior shapes safety.

So when we say “civil discourse is leadership,” we mean:

• Leaders set norms: what is tolerated becomes the curriculum.
• Leaders influence psychological safety: people take cues from power.
• Leaders translate conflict into learning: disagreement becomes improvement, not personal warfare.

Curiosity: the underused clinical superpower

Curiosity is not the opposite of confidence. It’s the antidote to overconfidence.

In clinical work, curiosity looks like:

• “Walk me through your thinking.”
• “What am I missing?”
• “What did you see that made you worried?”
• “What would change your mind?”

In leadership, curiosity does three practical things:

1. It lowers defensiveness by signaling respect.
2. It improves diagnosis of the real issue (often not the issue you’re arguing about).
3. It keeps teams flexible when conditions change (which, in health care, is basically always).

It also has a sneaky benefit: curiosity makes it harder to demonize colleagues. When you’re sincerely curious about someone’s reasoning, you’re less likely to treat them like a cartoon villain in a white coat.

The evidence link: civility, psychological safety, and patient outcomes

You don’t need a randomized trial to know that a hostile team is a fragile team. Still, the broader literature and safety guidance consistently emphasize that respect and psychological safety support communication, speaking up, and learningkey ingredients for reliable care.

Disrespect is a clinical risk factor

When people feel intimidated, they may hesitate to ask questions, challenge decisions, or report concerns. Leaders then lose crucial informationright when they need it most. In clinical terms, it’s like turning off telemetry because it’s “too noisy.” Sure, it’s quieter… until it isn’t.

Psychological safety isn’t comfort; it’s candor

Psychological safety is the shared belief that you can speak up, ask for help, or admit a mistake without being punished or humiliated. In health care teams, it’s strongly tied to learning behaviors: debriefing, reporting, problem-solving, and improvement.

Leaders build psychological safety less through speeches and more through micro-behaviors:

• How they respond to bad news
• Whether they invite questions
• Whether they admit uncertainty
• Whether they correct with dignity

Why medicine makes civil discourse harder (and why that’s not an excuse)

Clinical environments have built-in accelerants for conflict:

Hierarchy

Hierarchy is useful for speed, but dangerous for truth. If only the highest-status voice is “safe,” you get fast decisions and slow learning.

Time pressure

When the schedule is on fire, curiosity feels like a luxury. But skipping curiosity often creates rework, resentment, and errorswhich is the slowest kind of “fast.”

Identity and moral weight

Medicine is personal. People tie their sense of worth to competence and patient advocacy. That means disagreement can feel like a character attack even when it isn’t. Leaders must name that reality and still insist on respectful behavior.

Burnout and moral injury

Chronic overload narrows attention and shrinks patience. Leaders can’t “civility coach” their way out of structural problemsbut they can prevent exhaustion from becoming cruelty.

The leadership playbook: how to operationalize civil discourse with curiosity

If your team norms depend on “everyone just being nice,” you’re one bad week away from chaos. Leaders need repeatable practicessimple enough to use in real life.

1) Make discourse a standard, not a mood

Use explicit norms in meetings, rounds, and case conferences. Examples:

• Assume positive intent, confirm with questions.
• Critique ideas, not people.
• Disagree in the room, align outside the room.
• No “gotcha” questionsask to understand, then challenge.

Yes, it sounds like kindergarten. Medicine, however, occasionally behaves like a sleep-deprived kindergarten. So the reminder helps.

2) Teach teams a shared language for speaking up

Many systems use structured communication tools to reduce ambiguity and make escalation easier. Examples include:

• SBAR (Situation, Background, Assessment, Recommendation/Request) for concise handoffs and escalations
• CUS (“I’m Concerned,” “I’m Uncomfortable,” “This is a Safety issue”) for clear advocacy when safety is threatened

These tools aren’t about robotic scripts. They’re about giving people a safe, recognized way to raise concernespecially when hierarchy is steep.

3) Lead with curiosity prompts (and mean them)

Curiosity is a behavior you can practice. Here are leader phrases that work in high-stress clinical settings:

• “Help me understand what you’re seeing.”
• “What’s the risk if we’re wrong?”
• “What information would change our plan?”
• “Which constraint is driving your recommendationtime, capacity, policy, or safety?”
• “Can we separate facts from interpretations for a moment?”

Notice what’s missing: sarcasm, labels, and the classic leadership move of “I’m just asking questions” when you’re actually throwing knives.

4) Make “respect” observable and coachable

Vague feedback (“Be more professional”) rarely changes behavior. Make it specific:

• “When you interrupted three times, the resident stopped sharing information.”
• “That joke landed as ridicule. We need humor that doesn’t punch down.”
• “You raised a valid concern, but calling it ‘stupid’ shut the team down.”

Leaders should also reward positive behavior publicly:

• “Thanks for challenging that order respectfullygreat catch.”
• “I appreciate you naming uncertainty. That helps us stay safe.”

5) Use debriefs to turn friction into learning

After tense cases, use brief debriefs (2–5 minutes) with questions like:

• What went well?
• What was confusing or risky?
• What should we do differently next time?
• Did anyone feel unable to speak up?

Debriefs normalize learning and reduce the chance that conflict hardens into grudges and gossip.

6) Address disruptive behavior early and consistently

Civil discourse does not mean tolerating behavior that undermines safety or respect. When disruptive behavior goes unaddressed, it spreads. When it’s addressed consistently, norms strengthen.

A practical sequence many organizations use:

1. Describe the behavior (observable facts)
2. Explain the impact (on team function and safety)
3. Ask for their perspective (curiosity first)
4. Set the expectation (clear standard)
5. Support change (coaching, training, resources)
6. Escalate if needed (policy, formal processes)

This is not about “gotcha” discipline. It’s about protecting patients and teams.

7) Build systems that make civility easier

Leaders can’t demand calm conversation in a system designed to exhaust people. Civil discourse improves when leaders also improve conditions:

• Staffing that matches acuity
• Reasonable scheduling and recovery time
• Clear policies for reporting and addressing behavior
• Training for conflict management and feedback
• Support for clinicians experiencing harassment or bias

Curiosity here looks like asking, “What is the system asking people to do that makes professionalism harder?” Then fixing that, not just lecturing.

Specific examples: what civil discourse with curiosity looks like in real clinical moments

The ICU plan disagreement

Not great: “That makes no sense. We’re not doing that.”

Better: “I see why you’d want to escalate, but I’m worried about the hemodynamics. Can you walk me through your threshold and what you’re seeing?”

The OR speaking-up moment

Not great: Silence, hoping someone else notices the mismatch.

Better: “I’m concerned. The consent says left, but the marker is on the right. Can we pause and verify?”

The clinic conflict over capacity

Not great: “Admin doesn’t care about patients.”

Better: “Help me understand the constraints driving today’s schedule. Where is the bottleneck, and what would be a safer workaround?”

In each example, curiosity doesn’t remove urgency. It makes urgency more accurate.

How to measure progress (without turning this into a spreadsheet Olympics)

If leaders don’t measure, they guess. If they measure badly, they create theater. Aim for a few meaningful signals:

• Safety culture and psychological safety surveys (trend over time matters more than one score)
• Speaking-up behaviors (near-miss reporting, escalation events, debrief participation)
• Turnover and team stability in high-stress units
• Behavioral reports (look for patterns, hotspots, repeat issues)
• Observation: leaders rounding to listen for interruptions, dismissiveness, and follow-through

Also: ask your people. Not once. Repeatedly. Curiosity is a habit.

Experiences that bring the point home (composite stories from real-world patterns)

Note: The following are anonymized, composite scenarios drawn from common experiences clinicians and leaders describe across health care settings. They’re designed to illustrate patterns, not to represent any single person or institution.

Experience 1: The “brilliant jerk” who kept winninguntil the unit started losing

A high-performing specialist had a reputation: clinically sharp, fast decisions, and an allergy to questions. In case reviews, juniors learned to keep their heads down. Nurses stopped calling unless the situation was already on fire, because early calls were met with sharp comments and public criticism. Over time, the unit’s “efficiency” looked impressivefewer pages, fewer clarifying conversationsuntil the near misses started piling up. The quality team noticed a pattern: delays in escalation, incomplete handoffs, and a strange silence in debriefs. When leaders finally addressed it, the specialist’s first defense was predictable: “I’m just direct. People are too sensitive.”

The turning point wasn’t a lecture. It was a leader using curiosity like a scalpel: “What outcome do you want for this unit?” (Better patient care.) “What outcome are you actually getting?” (Hesitation, silence.) “What would it cost you to replace sarcasm with one clarifying question?” The leader then made expectations specific: no ridicule, no public shaming, and a requirement to model structured communication in high-risk moments. Coaching followed, plus a clear path for escalation if behavior didn’t change. The unit didn’t become conflict-free. It became truth-friendlyand that made it safer.

Experience 2: The case conference that turned into a courtroom

In a multidisciplinary case conference, a complex adverse event was presented. The room quickly split into camps. Someone implied, without evidence, that a colleague “wasn’t paying attention.” Another person started collecting receiptsscreenshots, timestamps, “gotcha” details. The conversation shifted from learning to blame. People stopped asking questions and started performing for the record.

A skilled facilitator paused the meeting and named what was happening: “We’ve moved from investigation to prosecution.” Then came the curiosity reset: “What do we know versus what are we assuming?” “Which part of this process made it hard to do the right thing?” “What would have helped a competent person succeed here?” The tone changed. Not because everyone felt warm and fuzzy, but because the group returned to a shared goal: reducing harm in the future. By the end, there were concrete system fixes, and the individuals involved were treated with dignity. The message became: accountability and respect are not enemies; they’re teammates.

Experience 3: The resident who finally spoke upbecause the leader made it normal

A resident noticed a medication plan that didn’t fit the patient’s renal function. In the past, this resident had been brushed off by a senior clinician with, “We don’t have time for this.” This time, the attending opened rounds with a simple ritual: “One thing I might be missing today?” The resident hesitated, then used a structured approach to raise the concern. The attending didn’t respond with annoyance; they responded with curiosity: “Show me your reasoning.” Within minutes, the plan was adjusted. The leader then did something small but powerful: they praised the speaking-up behavior in front of the team and thanked the resident for protecting the patient.

That one moment became a local legendnot because it was dramatic, but because it changed what people expected. The team learned: bringing concerns is normal here. Curiosity is not a threat. And “being wrong” is survivable.

Experience 4: The leader who thought civility meant “no emotion”

A department tried to promote civil discourse by banning “negative tone” in meetings. The unintended effect: clinicians felt they couldn’t express frustration about understaffing, patient backlog, and safety risks. Meetings got quieterand more cynical. Complaints moved to hallways and group chats, where they grew sharper and less solvable.

Eventually, leadership revised the approach. Instead of “no emotion,” the norm became “no disrespect.” People could voice anger and grief, but they had to do it without demeaning colleagues. Leaders modeled curiosity: “What’s the story behind that frustration?” and “What would make this safer next week?” The department didn’t magically become calm. It became honest. And honest teams can improve.

Conclusion: curiosity is the behavior that makes discourse safe enough to be useful

In medicine, disagreement is inevitable. Complexity guarantees it. What leaders control is whether disagreement becomes learningor becomes damage.

Civil discourse is not a decorative value statement. It’s an operational competency that supports patient safety, teamwork, retention, and trust. Curiosity is how leaders make it real: asking better questions, reducing defensiveness, and turning conflict into clarity.

If you’re leading in health care, you don’t need a perfect culture. You need a culture where people can say, “I’m concerned,” and the room gets safernot quieter.