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
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
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.
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
He has treated many doctors with substance abuse disorders that often mask
underlying psychiatric disorders, he noted (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>.▪