Taking a Fresh Look at Disruptive Physician Conduct

The reason that I entitled this post “A Fresh Look at Disruptive Physician Conduct” is that I was pleased that it had been selected for presentation at a major surgical meeting. For too long, this subject has been swept under the rug. I am glad that it is being discussed by people who can recognize it and improve the environment for change.

The reason that I entitled this post “A Fresh Look at Disruptive Physician Conduct” is that I was pleased that it had been selected for presentation at a major surgical meeting. For too long, this subject has been swept under the rug. I am glad that it is being discussed by people who can recognize it and improve the environment for change.

Methodology

A surgeon and a PhD colleague asked 19 Operating Room (OR) staff members two questions:

• Can you tell me about a time when you saw a surgeon demonstrate disruptive behavior? (defined as conduct that negatively affects patient care or has the potential to affect patient care negtively. Cochran A, Elder B. J Am CollSurg 2014:290:390-398)
• Please explain why you believe the surgeon behaved in this way.

Their interviews of anesthesiologists, nurses, medical students, and OR technologists led to the postulation of three major factors that led to disruptive behavior by surgeons:

• Personality factors: surgery may attract perfectionistic people who thrive in the face of constant challenge and lack of positive reinforcement
• Culture: medical students and residents who are treated in a disrespectful fashion by attending surgeons behave the same way once they become attendings because they learn no other way of behaving and see that such behavior is rarely challenged due to the attending surgeons’ perceived power and because of the revenue that these surgeons bring in
• Situational stressors: When something goes wrong, it may challenge a surgeon and trigger feelings of inadequacy and shame that manifest as anger and blame. Not having the same people in the OR may also trigger anger and fear that something may go wrong

Recommendations

The authors cite multiple references that disruptive behavior imperils patient safety, increases the cost of care, and increases staff turnover. They cite:

• The need for interprofessional education events, especially for novices in the process of learning to navigate a challenging environment
• Remediation of behavior that results in verbal hostility, as practiced at Vanderbilt’s Center for Patient and Professional Advocacy and at the University of Miami’s Pulse Program
• Conflict management training for everyone who works in an OR setting

Turning a blind eye to tantrums, threats, and intimidation is inimical to change. The goal is to improve patient safety through reforms at the individual and system level that enhance dialogue and mutual respect and create a safe environment for learning.

As always, I welcome your input to improve healthcare collaboration where you work.  Please send me your comments and suggestions for improvement.

Kenneth H. Cohn © 2014, all rights reserved

Disclosure: I have not received any compensation for writing this content.  I have no material connection to the brands, topics and/or products that are mentioned herein.

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