The disruptive doctor has become almost a cliché: the hot-tempered egomaniac who flies off the handle, berating nurses or other coworkers further down the hospital pecking order for their incompetence. Like most clichés, this one unfortunately has some basis in fact. Several studies make this phenomenon disturbingly clear: Disruptive physician behavior is an issue that is too important to ignore.
Like all behaviors, bad behaviors exhibited by doctors have tangible consequences. Doctors who behave badly create a ripple effect that filters down to nurses, patients, and their families, ultimately affecting patient outcomes along with patient and job satisfaction scores. Roughly 60 percent of health care organizations in one study said they have received written complaints about physician behavior from patients or their families; 50 percent report that patients changed doctors or left a practice when their doctor was rude. More than 20 percent felt that an adverse clinical event was the direct result of a doctor’s behavior. A telling 99 percent believe that disruptive behavior ultimately affects patient care.
According to a report in the Archives of Surgery having a rude surgeon in the OR can negatively affect health care costs, medical errors, and patient health and satisfaction. Other research suggests a link between surgeon civility and fewer postoperative deaths and complications; it notes supportive research that found 75 percent of hospital pharmacists and nurses avoid physicians who are rude or difficult to work with even when they have questions about a patient’s medication.
Types of Disruptive Behaviors: The Overt, the Insidious
Bad behavior can erupt in many forms. Some, such as insults, profanity, or yelling, are easy to identify. But other disruptive behaviors―such as doctors refusing to cooperate with other health care providers or failing to follow established protocols―can be subtle and even more damaging.
A recent survey conducted by the American College of Physician Executives (ACPE) revealed decidedly mixed results regarding how effective health care organizations have been at addressing disruptive doctors. Although two thirds of respondents said their institutions have established policies to prevent such incidents, almost 25 percent said they felt uncomfortable confronting physicians who were exhibiting disruptive behavior, and 77 percent believed they needed training to learn how to better manage disruptive physician behavior. The silver lining in these results is that they point to an opportunity for health care organizations to improve their organizational culture, to offer education and support to offending physicians, and to address disruptive behavior before it impacts patient care and satisfaction.
Although it doesn’t excuse disruptive behavior, some note that many doctors unfortunately learned this behavior from abusive instructors in medical school. The long hours, stress, and diminishing financial rewards of the health care work environment are also contributing factors. Recommendations to counter learned behaviors include encouraging an environment of civility along with building confidence, a strong work ethic, and dedication during the surgeon’s training and hiring surgeons based not only on case volume or grant funding, but also considering a physician’s interpersonal skills.