Negative behaviors displayed by surgeon can jeopardize care

Unhappy with everything from his marriage to frustrating reimbursement schedules, a surgeon gains a reputation for having a short fuse and angry outbursts, causing nurses to avoid asking him for help. Frustrated with similar issues, another surgeon is more passive, but stingingly sarcastic and disrespectful, prompting the same response from nurses. Both behaviors would classify as being disruptive, and can have far-reaching consequences.

While a recent survey looking at the problem concluded that only about three percent to five percent of physicians actually exhibit such behaviors, the bad news is that that vocal minority can impact the vast majority of those around them, spreading ill will throughout a medical setting that, like a cancer, can compromise the function of various other parts.

SURVEY SAYS:

Even more alarming were the consequences: As many as 71 percent felt that there was a link between the stress and frustration that the disruptive behavior caused and medical errors.

As many as 27 percent of respondents felt that there was even a link to patient mortality, and 18 percent said they knew of a specific adverse event that occurred as a direct result of disruptive behavior, with 75 percent of those indicating that they felt the adverse effect could have been prevented.

"We previously reported that disruptive behavior among physicians was resulting in serious problems with nurse retention, and we decided to look at the psychological factors of the disruptive behavior, including stress, lack of concentration and poor communication, and how that was affecting patient care, and what we found was striking," says Alan Rosenstein, M.D., vice president and medical director of Physician Wellness Services at VHA and co-author of the study.

In the comment section of the survey, the respondents described how disruptive behavior was directly impacting the quality of care they were able to offer patients: "Most nurses are afraid to call Dr. [X] when they need to, and frequently won't call. Their patients' medical safety is always in jeopardy because of this," one respondent wrote. "Poor communication post-op, because of a disruptive reputation, resulted in delayed treatment, aspiration, and the patient's eventual death," wrote another.

The findings contributed to a sentinel alert from the Joint Commission requiring that health care organizations adopt zero-tolerance policies for disruptive physician behavior by January 1, 2009.

Dr. Rosenstein's survey only evaluated hospital settings, but the problems of disruptive behavior, intimidation and anger are also prevalent in group and even private practices, he notes.

"The intensity may not be as strong as in a hospital, but the problems can be just as bad or worse because there isn't as much oversight," Dr. Rosenstein says.

INTIMIDATED BY THE INTIMIDATOR

In most cases, those around them are far too intimidated to speak up. In its alert, the Joint Commission noted another survey on intimidation, conducted by the Institute for Safe Medication Practices, which found that as many as 40 percent of clinicians said they have kept quiet or remained passive during patient care events rather than question a known intimidator.

"Even other physicians will simply look the other way because the physician may be prominent and brings in a lot of patients to the hospital and is therefore a big source of revenue for the hospital," Dr. Rosenstein says.

Specialties appearing most prone to problems with disruptive behavior include, logically, high-intensity fields such as general surgery, cardiovascular surgery, neurosurgery, orthopedic surgery and obstetrics.

But with documentation of the adverse impact on patient care and threat of lawsuits arising resulting from failure to address disruptive individuals, the problem is attracting more attention and more physicians are being held accountable for their behavior.