“We’re talking about a very small number of physicians, but the ripple effect is profound,” said Charles Samenow, an assistant professor of psychiatry at George Washington University School of Medicine, who evaluates doctors with behavioral problems.
For generations, bad behavior by doctors has been explained away as an inevitable product of stress or tacitly accepted by administrators reluctant to take action and risk alienating the medical staff, particularly if the offending doctors generate a lot of revenue. Recently at one Virginia hospital, according to University of Virginia School of Nursing dean Dorrie Fontaine, a veteran operating-room nurse with 30 years’ experience walked into her supervisor’s office and quit after a surgeon screamed at her — his usual reaction to unwelcome news — when she told him that a routine count revealed that an instrument was missing. Hospital administrators shrugged off the episode, saying, “Well, that’s the way he is.”
But that time-honored tolerance is waning, Samenow and other experts say, as a result of regulations imposed in 2009 by the Joint Commission, the group that accredits hospitals. These rules require hospitals to institute procedures for dealing with disruptive behavior, which can take passive forms such as refusing to answer pages or attend meetings. The commission has called for a “zero tolerance” approach. Such behavior is not unique to doctors; researchers have found that nurses act out, too, mostly to other nurses, but that their behavior is less likely to affect patients.
Corrosive effect on morale
Growing attention to the problem, which appears to be most common among surgeons and other specialists who do procedures, has spawned a cottage industry of therapists who provide anger management counseling, which is sometimes billed as “executive coaching.” Programs are flourishing at Vanderbilt, the University of Virginia, the University of California at San Diego and, most recently, GWU.
Most doctors who enroll are middle-aged men sent by hospitals or state medical boards that have ordered them to shape up.
Experts say that doctors’ bad behavior is not merely unpleasant; it also has a corrosive effect on morale and poses a significant threat to patient safety. A 2011 survey of 842 hospital administrators for the American College of Physician Executives found widespread concern: 71 percent said disruptive behavior occurs at least monthly at their hospital, while 11 percent said it was a daily occurrence. Ninety-nine percent said they believed such conduct negatively affected patient care, while nearly 21 percent linked it to patient harm. Those findings mirror a 2008 study of more than 4,500 doctors and nurses, in which 71 percent tied it to a medical error and 27 percent to the death of a patient.