Doctors Behaving Badly, and Patients at Risk

It’s the rare person who never loses his or her temper, never has a meltdown. Doctors are no different, except that their bad behavior can cause harm to someone who expects them to do the opposite. When that happens, especially in a hospital, as a recent story by Kaiser Health News/Washington Post said, “… doctors’ bad behavior is not merely unpleasant; it also has a corrosive effect on morale and poses a significant threat to patient safety.”

In a 2011 research paper called “Disruptive Physician Behavior,” 842 hospital administrators were surveyed by the American College of Physician Executives. More than 7 in 10 said disruptive behavior occurs at least monthly at their hospital; more than 1 in 10 said it was a daily occurrence. Nearly all-99 in 100-said they believed such conduct negatively affected patient care, and 1 in 5 associated it with patient harm.

Those results pretty much replicated a 2008 study by The Joint Commission Journal on Quality and Patient Safety of more than 4,500 doctors and nurses. More than 7 in 10 of them said bad behavior had been responsible for a medical error and more than 1 in 4 said it had led to the death of a patient.

Sometimes it’s a matter of poisoning the work environment. During a complex abdominal operation in 2011, a surgeon was handed a device that had been improperly prepared by a surgical technician. The doctor slammed it down in anger, accidentally breaking the technician’s finger. The surgeon was suspended for two weeks and told to attend an anger management course for doctors.

Many hospitals, the story relates, have been slow to address the problem of disruptive, angry doctors, most of whom are surgeons or other specialists. One study in the Journal of Medical Regulation estimated that 3 to 5 in 100 physicians exhibit unacceptable behavior such as berating nurses who call them in the middle of the night about a patient, throwing scalpels at trainees they perceive as slow, demeaning co-workers they consider incompetent or cutting off patients who ask a lot of questions.

For a long time such behavior was tolerated, excused, even, because the practice of medicine is so stressful and because hospital administrators were reluctant to confront people who might be generating a lot of revenue for their facility.

Although boorishness is increasingly being recognized, sometimes it still wins-at a hospital in Virginia recently, an operating-room nurse with 30 years’ experience quit after a surgeon screamed at her-again–when she told him that an instrument was missing. According to KHN/Washington Post, hospital administrators said only, “Well, that’s the way he is.”

In 2009, the Joint Commission, the independent, nonprofit organization that accredits hospitals, imposed regulations requiring hospitals to institute procedures for dealing with disruptive behavior. It recommended a “zero tolerance” approach for health professionals who act out. That includes nurses, but researchers say that they mostly do so toward other nurses, and that their behavior is less likely to affect patients.

Hospitals and state medical boards are starting to refer these brutes to one of the anger management counseling programs designed specifically for a physician clientele. Sometimes the program is called “executive coaching,” but that’s just a euphemism for “get your act together, you jerk.” Most of the docs enrolled are middle-aged men who have been ordered to attend.

“Many hospitals and health-care systems are beginning to address it just to keep their accreditation,” Peter Angood, formerly chief patient safety officer at the Joint Commission, told KHN/Washington Post. He compares the problem to road rage, and says it, too, can have deadly consequences.

Laura Sweet, deputy chief of enforcement for the Medical Board of California, told KHN/Washington Post that the licensing body has investigated several maternal or fetal deaths that occurred because nurses failed to contact doctors about a worrisome reading on a fetal monitor “for fear of being chastised or ridiculed.”

The story recalls one nurse who called a physician at home because a patient in the intensive care unit had developed aspiration pneumonia. That occurs when food or vomit is inhaled into the lungs, and it can be lethal. The doctor criticized the nurse’s training and did nothing. The patient died.

Then there was the surgeon who kicked an anesthesiologist out of the operating room after the two had argued. That left the patient unmonitored during surgery, a serious breach of safety.

Alan Rosenstein, a researcher/physician, found that bad behavior by doctors drives nurses out of the profession, and contributes to the nursing shortage. Rosenstein, former West Coast medical director of the VHA hospital network, told KHN/Washington Post that poor conduct also can lead to lawsuits by employees alleging the existence of a hostile workplace, and that hospitals just can’t afford to ignore the problem.

Changes in how health care is delivered, the demand that doctors see more patients, reduced nursing staffs, the way doctors are trained in medical school and the professional uncertainty that comes with hospitals buying up medical practices can cultivate bad behavior, some experts suggest.

But that doesn’t excuse unacceptable behavior-medicine is inherently stressful and learning to handle it is part of the job. The KHN/Washington Post story noted that most doctors who participate in anger management programs have long histories of conflict with colleagues and administrators. In other words, they don’t act out in one extreme case, they have a pattern of rude, inappropriate conduct.

To her credit, the surgeon who broke her colleague’s finger in an OR hissy fit was distraught by her behavior. She attended the anger management program at her own expense. Now in her mid-40s, she told KHN/Washington Post that she had behaved as she had been taught by the men in charge of her residency and fellowship training. One of her mentors once threw an instrument at her in the OR.

Many people in these programs are superior technicians and are beloved by patients, even if their colleagues can’t stand them. One professor of psychiatry told KHN/Washington Post that often they’re narcissistic, compulsive perfectionists who defend their behavior by saying they acted in the best interests of their patients.

But even they need to be smacked upside the head. William Swiggart, the director of Vanderbilt’s Program for Distressed Physicians, tells participants in the course (cost: $4,500), “This is a course based on how you’re perceived. I’m happy to assume your heart’s good. But your behavior sucks.”

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