Problem Physicians Pose Challenge for M.D. Execs

Nursing shortages, patient safety, and the threat of lawsuits are driving physician executives to address staff complaints about physician behavior.

Nearly all of the 1,627 physician executives who completed a national survey had encountered one or more physicians with disruptive behavior in the preceding year. About a third of them said they encountered problem behaviors monthly or weekly.

Nurses, physician assistants, and pharmacists complained of being berated, belittled, or cursed at by doctors. Staff also complained about physicians who worked under the influence of drugs or alcohol, refused to answer pages, missed appointments, and breached sexual boundaries, according to the survey results published in the September/October issue of The Physician Executive, a publication of the American College of Physician Executives. That organization e-mailed its survey to 7,000 members in May. The response rate was 23 percent, resulting in 1,627 completed surveys of physician executives of hospitals, group practices, health care systems, and academic medical centers.

Nearly 70 percent of the respondents said that a few “bad apples” repeatedly violated boundaries including workplace rules and ordinary social norms. About 30 percent of the respondents said several doctors were disruptive once or twice but rarely repeated the offensive behavior. “Those individuals, once they settle down, are generally ashamed of their behavior and rarely repeat,” one respondent commented.

Conflicts With Other Staff

One in three respondents said the disruptive or abusive behavior occurred when there was a conflict between the physician and a nurse or physician assistant. One in four executives said physicians were taking out their frustrations with workplace changes such as managed care, Medicare regulations, economic pressures, and working more hours with fewer resources, the article stated.

One in four physician executives pinned the problem behaviors on physicians who don't embrace teamwork. One respondent commented that many hospitals have reacted to the nursing shortage by paying nurses a fixed daily rate or hiring them from agencies. Because the nurses are not employed by the hospital and are often there for short periods of time, physicians are less inclined to accept those nurses as part of a team, the article suggested.

Half of the physician executives who completed the survey believed their staff were reluctant to complain about a physician's behavior unless it was“ completely out of line or a serious violation of workplace rules,” according to the article.

Are Sanctions Too Lenient?

More than half of the respondents believed that doctors are treated more leniently than other employees because of their professional stature. However, one respondent explained that doctors in community hospitals are private volunteers who in most cases are not subject to employee policies established by the organization's human resources department.

Nearly all respondents said they talked to the physician about his or her disruptive behaviors. Two-thirds issued a written warning to the offending doctor, and half said they ordered the doctor to seek counseling.

“Those of us who work in the field of physician health are increasingly urging physician leaders to have policies and procedures in place to address a physician's disruptive or negligent behaviors,” Michael Myers, M.D., chair of the Section on Physician Health of the Canadian Psychiatric Association, told Psychiatric News. “We encourage them to address problem behaviors right away rather than waiting until a patient is harmed or a malpractice lawsuit filed.”

Myers, who is chair of the Psychiatric News Editorial Advisory Board, co-edited The Handbook of Physician Health: The Essential Guide to Understanding the Health Care Needs of Physicians with Leah Dickstein, M.D., and Larry Goldman, M.D. The book is published by AMA Press.

Myers has devoted his private practice in Vancouver, British Columbia, to evaluating and treating medical students, physicians, and their families.“ Most of my patients are sent to me by their supervisors, who make it clear to them that they can't practice medicine unless they get treatment,” Myers said.

“Initially, they are furious about this mandate and are very defensive about any complaints of misbehavior. Some doctors hire lawyers and file lawsuits against the person who made the complaint,” said Myers.

He has treated many doctors with substance abuse disorders that often mask underlying psychiatric disorders, he noted (Original article: see article below).

“I have talked to a ton of doctors who were called on the carpet by their bosses, pulled from the job, and sent away for treatment. Once they are well, they often can't believe they behaved as they did. They realize that were imploding and would not be here today if their bosses hadn't intervened,” Myers said.

The study, “Poll Results: Doctors' Disruptive Behavior Disturbs Physician Leaders,” is posted online at<www.acpe.org/PEJ_Article/DisruptivBehavior_Weber.pdf>.

The Handbook of Physician Health: The Essential Guide to Understanding the Health Care Needs of Physicianscan be ordered online at<https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod170040>.▪