Troubled Docs

October 21, 2004

Heather Heilman
Phone: (504) 865-5714

Physicians have some of the most demanding and stressful jobs out there.

keoghYet nurses and others employed in hospitals and clinics do work that is often equally as difficult, and their jobs are made even more stressful when they have to deal with physicians who curse, berate or otherwise treat them disrespectfully.

"It's a nurse retention issue," said Tim Keogh, associate professor of health systems management. "We don't want disruptive physicians to tear the fabric of a unit."

Keogh and a colleague at DePaul University conducted a survey of about 1,600 physician executives throughout the country. The results suggest that, while most physicians behave appropriately on the job, a small minority of disruptive doctors can create big problems.

These are doctors who scream insults, throw things and refuse to carry out assigned tasks. Most often the abuse is directed at nurses, physician assistants and others in subordinate positions.

The doctors often are not punished for their inappropriate behavior, or are treated leniently because of their professional stature. It's not that they're bad doctors or bad people. They care about their patients.

They feel pressured from a number of different directions. And when stress builds they react by taking out their frustrations on those around them. If no one ever calls them on it, they may think their behavior is acceptable.

During their training they may have seen other doctors do similar things and come to assume that this is their prerogative as physicians. Contrary to stereotypes, Keogh sees no distinction among specialties or between male and female physicians when it comes to disruptive behavior.

"It's not the case that pediatricians are necessarily warm and caring or that surgeons are temperamental," he said.

Keogh teaches physician executives in Tulane's master of medical management program and in special courses offered through the American College of Physician Executives. His students are doctors who have assumed administrative duties in addition to their clinical work.

He tells them that problems with disruptive physicians can be difficult to fix once they become entrenched. It's important to prevent problems in the recruiting and hiring process by setting clear expectations for behavior. Administrators have to be clear and specific about what will not be tolerated.

"When one of these disruptive events happens, you can't go in there and say, 'We heard some yelling in the hall and we want you to be nice to the nurses,'" Keogh said. "Because then the physician will say, 'If you had to work with nurses like these you'd be yelling, too.' Instead you have to say that on a specific date at a specific time, you heard the physician use language that will not be tolerated. You have to quantify everything in some fashion."

Clear policies and procedures must be put in place--otherwise doctors assume a problem will be dealt with on a case-by-case basis and there is a risk of treating some doctors more leniently than others. The idea is to change the physician's behavior, not the physician's character.

Physician executives may be somewhat more effective in dealing with disruptive physicians, who are more likely to see such executives as colleagues who understand their focus on patient care. Results of the survey appear in the September/October issue of The Physician Executive.

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