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Most physician executives have encountered disruptive physicians

Patient Safety Monitor Alert, August 31, 2004

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Does your three-year-old throw things, scream, and pout when he doesn't get his way? He has a lot in common with disruptive physicians around the country.

More than 95% of physician executives who responded to a recent survey say they encounter behavior such as screaming, insults, throwing surgical instruments, and berating nurses on a regular basis. In many cases, the doctors who exhibit these types of disruptive behaviors are seldom punished.

That's bad news for your patients - and your organization's bottom line. Disruptive physicians endanger patient safety by creating an environment in which nurses, residents, and other clinicians are afraid to question care or speak up about a potential error. In fact, disruptive behavior is a root cause of some of the medical errors that the JCAHO has identified as sentinel events.

It also puts your organization at risk for litigation, increases employee turnover, and can hinder your hospital's ability to protect in the event of a lawsuit.

More than 1,600 physician executives responded to the survey conducted by the 10,000-memberAmerican College of Physician Executives, based in Tampa. Results appear in the September/October issue of The Physician Executive.

Among the results:

>> More than 78% say they observe "problems with physician behavior" at least monthly
>> Fourteen percent say they observe disruptive behavior weekly
>> Three percent observe disruptive behavior daily

Disruptive behavior included insults, disrespect, yelling, physical abuse, and refusing to answer pages, complete tasks, or carry out duties.

Alcohol and substance abuse accounted for no more than 10% of physician behavior problems, according to the report.

The bad behavior tends to come from the same physician. About 70% of respondents said that disruptive behavior problems "nearly always involve the same physicians over and over again."

When physicians do misbehave, their outbursts are more likely to fall upon nurses or physician assistants (57% of outbursts, according to rounded data) rather than other physicians (15%), administrators (15%), or patients (14%).

"Lots of arrogant, immature snots [are] practicing medicine," one respondent commented.

The respondents should know; nearly 90% of the physician executives who answered the survey indicated that they are responsible for investigating complaints about disruptive physicians. But when it comes to disciplining the doctors, many executives say their hands are tied.

About 47% said their disruptive physician policy is "selectively" enforced for physicians, who tend to bring in revenue for the hospital.

"Surgeons are permitted to act out more because they generate more money, and there is the perception that 'this is just how surgeons behave,' " according to one survey respondent.

Flashback: The Institute for Safe Medication Practices (ISMP) earlier this year unearthed a "culture of disrespect" in which abusive and intimidating behavior is widespread and tolerated. In a survey of 2,000 nurses, pharmacists, and other healthcare workers, 88% said they encounter condescending language or tone of voice from coworkers.

A Canadian study published in the March 2003 issue of Health Policy shows that one in five nurses experiences at least two of the following types of unwanted behavior from a coworker: physical assault, threat of assault, emotional abuse, verbal sexual harassment, or sexual assault.

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