In recent years there has been a major push by medical associations, accrediting agencies and health care organizations towards diminishing physicians’ historically tolerated tendencies to misbehave, to treat others poorly, to intimidate, etc. None of us who works in health care needs an introduction to this topic. There are still plenty of remnants of physician disruptive behavior evident in our organizations.
Dr. Norman Reynolds’ article on the topic in the Journal of Medical Regulation is a good starting point for the interested and offers a broad overview:
In it, he excerpts a table from the Federation of State Medical Boards which lists some examples of disruptive behaviors:
“… two types of dysfunctional physician behavior can be identified. One type is abusive behavior, which can be verbal (insults; condescension; or unwarranted attacks on the honesty, integrity, or competence of another) or physical (contact that is embarrassing, threatening, intimidating, or injurious and invades another’s physical or psychological space). The other type is disruptive behavior, which alters clinical care in a way that is either not beneficial or actually harmful to the patient. Mean, abusive, and disruptive (MAD) behavior among medical professionals interferes with the cooperation, teamwork, and communication necessary to fulfill the obligation of physicians to put the patient’s interests foremost.”
These behaviors are “… frequently part of a personality disorder that reflects a person’s innate character and is not merely an exaggerated response to immediate environmental conditions.” (italics added)
“… (T)he issue should be addressed according to the policies and procedures of the hospital system involved—often by making a report to the administration regarding the behavior and asking for an investigation.”
An excerpt statement from the AMA policy on Physicians and Disruptive Behavior (that link is now disabled, but check out the AMA Code of Ethics statement):
“It may affect the broader operations of an institution, or relate more narrowly to one’s ability to work with others, such as unwillingness to work with or inability to relate to other staff in ways that affect patient care. In addition, it may have negative effects on the learning environment of an educational institution—by modeling inappropriate behaviors for students and residents, and by impairing their ability to achieve clinical skills. Behavior that tends to cause distress among other staff and affect overall morale within the work environment, undermining productivity and possibly leading to high staff turnover or even resulting in ineffective or substandard care would fall within the definition of disruptive behavior.”
from the medical director of The Joint Commission:
“While the most compelling reason for addressing
disruptive and intimidating behavior has been the clear demonstration that it can be harmful for patients,1,2 there are other reasons. Individuals who have a history of disruptive
behavior also pose the highest litigation risk for American hospitals, and many would argue that such behavior is inconsistent with the highest professional standards.6,7,8 Such behavior also contributes to poor teamwork, difficult work environments, poor patient satisfaction, and problems recruiting and retaining nursing staff.3″
This graphic is a screenshot of a disruptive behavior policy of the largest hospital and medical center in St. Louis. This was easily acquired with a simple webpage search. A similar policy should be readily located at all of our institutions. Complaints of disruptive behavior should be easily reportable through both hospital and medical school channels. Additionally, abuses can be reported through state medical licensing boards (Board of Registration for the Healing Arts
in Missouri), specialty medical boards, and/or the ACGME. Here
are some more thoughts on what you can do.
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