Few people have true dialogs. Typically, it is one person’s monolog followed by the other person’s monolog. In my humble opinion, we do this to elevate ourselves above the other person. For example, Person 1: “My son lost two teeth this weekend. The tooth fairy put $2 under his pillow.” Person 2: “My daughter lost a tooth last week. She doesn’t believe in the tooth fairy.” Person 1: “I felt so bad for him. He was afraid to let me pull it out even though it was just hanging by a thread. It finally came out 3 hours later.” Person 2: “My daughter is tough. When her teeth get loose, she just pulls them out.” Was that a dialog? No. It was a dual of monologs—maybe better stated as a “duel” of monologs.

How about this instead: Person 1: “My son lost two teeth this weekend. The tooth fairy put $2 under his pillow.” Person 2: “Wow, how old is he anyway?” Person 1: “He is 5, almost 6.” Person 2: “What a great age, what else is he doing?” Yada yada yada. Now that is a true dialog.

In our profession, I have noticed that BMETs are not nice to one another. Wow, what a general statement! I am a BMET, and I am nice! It isn’t me, is it? Everyone I work with is kind toward our clinical staff, administration, competition, fellow BMETs, family, and friends.

We tend to elevate ourselves above everyone else, at least in our own minds. It is my opinion that our profession does this all the time in our references to those we work with: Nurses don’t even know how to change a bad RL lead when it is broken, or administrators are dim-witted, the floor we renovated 3 years ago for purchasing is now being transformed into sleeping quarters for interns. Or, how about those new BMETs—do they know anything? They never even studied electron tube theory! I am smarter than they are (at least in my own mind). And, of course, those IT folks—ha! They don’t do anything!

Real quick, let me tell you about my actual life experiences. The vast majority of nurses I have worked with in my life are great. I could never do their job. The administrators I have worked with run a billion-dollar business and have made a profit for the past 140 years in an industry that is more complicated than many others. The new biomed technicians are doing things that I would have to go back to school to learn. I can’t even fathom how much a physician has to study and know. I recently worked on a project with one of our senior network IT administrators. Between us, I do not have 1/1000th of the knowledge that he has in his field. PS: I am a geek with six home computers, a wired and wireless network, and a Web server.

Well, I have some good news for all of us: We are not the only profession that eats its young or puts others down to make ourselves look better. It is so prevalent that there is a name for it: horizontal violence. Try doing a Google search and you will wind up with more than 454,000 hits. What is it? Why do we do it?

According to Duffy,1 horizontal violence is hostile and aggressive behavior by individual or group members toward another member or group of members of the larger group. Generally defined as nonphysical intergroup conflict, horizontal violence is characterized by obvious and concealed hostile behavior. Often, these are psychologically, emotionally, and spiritually damaging behaviors that can have harmful long-term effects on the recipients. Horizontal violence is a symptom of feeling oppressed or powerless, which leads to an internalized self-hatred and low self-esteem.

Understand this. You are special; no one else is like you. (Didn’t Mr Rogers say that?) The next time you find yourself cutting someone down, be aware of it. Try to do it less and less. You may actually find your self-worth grow by doing the exact opposite of what seems to come naturally—cutting others down. Just be nice. By the way, I need as much help with this as anyone. I am working on it.

Michael R. Kauffman, CBET, is assistant director of facilities, The Reading Hospital and Medical Center, Reading, Pa; and is a member of 24×7’s editorial advisory board. For more information, contact .


  1. Duffy E. Horizontal violence: A conundrum for nursing. Collegian Journal of the Royal College of Nursing. 1995;2(2):5-17.