Posted on: Wednesday, September 22, 2004

Rude doctors put patient lives at risk

By Valerie Reitman
Los Angeles Times

Almost any hospital or large clinic has a physician who forgets bedside manner when it comes to dealing with staff.

He yells and screams. She makes condescending remarks — "When did you graduate from medical school?" — when suggestions are made. He blames others for problems beyond their control.

But few of these rude physicians are disciplined or punished — particularly if they are big moneymakers, bringing the institution prestige and lots of patients.

About 95 percent of physicians who manage hospitals, group practices and clinics said they have to deal with such disruptive physician behavior regularly, according to a survey by the American College of Physician Executives. Most of the incidents, they noted, involve the same few doctors.

"We have a horrible track record in our own profession of even recognizing physicians with difficult personalities, much less dealing effectively with them," one administrator wrote.

The survey, which was answered by 1,600 of the 7,000 medical administrators to whom it was given, was designed and administered by two professors who teach management skills to physicians.

Every profession has its share of jerks and folks not well versed in simple etiquette, but the problem can be more troublesome — even dangerous — in a hospital or large clinic, distracting staff members from patient care, the researchers said.

"Although it is only a small number of doctors who do this, the impact is much greater than the numbers," said Tim Keogh, associate professor at Tulane University and a co-author of the study.

"It tears at the fabric of a floor or unit. ... People go around the troublesome doctors or avoid them — and teamwork falls. It's behavior that shouldn't be tolerated."

Because members of these medical teams often work closely together and depend on each other, that meanness or condescension can increase stress and contribute to staff burnout and turnover, added co-author Marty Martin, associate professor at DePaul University.

"If you work in an environment where there's ill will or disrespect, then you are distracted and not focused," he said, and thus more likely to make mistakes.

The bulk of the bad behavior is vented on nurses or physician assistants, the survey revealed, rather than on other physicians, patients or administrators. Disrespect was by far the most frequent problem cited.

Doctors who repeatedly commit such acts should be disciplined or punished and have their pay docked, the researchers maintain.

Hospitals and large clinics, they suggest, should have formal policies laying out codes of conduct for physicians. Specific instances should be noted when the physician in question is being asked to improve.

But even when such policies are in place, there is often reluctance to intervene; action typically occurs only after repeated complaints from the staff or in egregious cases when a physician is completely out of control.

Abusive incidents are more likely to occur in stress-filled units such as the emergency room, the oncology wards or the operating rooms, the researchers said, where procedures must be done immediately.

"There are more life-and-death issues, and the way care is delivered is more team-based, and there's more interaction," Martin says.

Disciplinary measures are easier if the doctor is on the staff of the hospital, although even so, about two out of three of the administrators said physicians were treated more leniently than other employees because of their professional stature.

But most physicians who admit patients to a hospital or perform surgery are private practitioners who contract their services to the hospital. Hence, disciplinary measures become even more difficult, particularly with high-profile doctors.

About 40 percent of respondents said physicians in the organization who generate more revenue (by bringing in more patients or performing more operations) are treated more leniently than those who bring in less.

Such disciplinary matters generally require review by a hospital medical board.

Researcher Martin, who is also a psychologist, now counsels three abusive physicians. "Their attitude is, 'Why is everybody making such a big deal about it?' So one of the first things we have to do is help them understand their impact on others," Martin said.