Docs Gone Bad: Your top doc just threw a tantrum. Now what?

In the more than ten years that Paul Levine, MD, FACS, has served as chair of otolaryngology and head and neck surgery at the University of Virginia in Charlottesville, he has heard his share of complaints about high-powered surgeons who are difficult to work with. Although stories about doctors who throw instruments—or punches—make headlines, verbal abuse is more common, Dr. Levine said. “Many times, nurses and junior colleagues are the targets of the surgeon’s verbal attacks,” he added.

In today’s hospitals and medical offices, you might hope that tales of abusive doctors would be rare. After all, the Accreditation Council for Graduate Medical Education’s six core competencies that training programs are expected to instill in new physicians include systems-based practice (basically, working in teams), interpersonal skills and communication and professionalism.

But despite efforts to instill a higher level of professionalism, disruptive doctors are still far more common than they should be. A 2004 survey by the American College of Physician Executives found that more than 95 percent of the more than 1,600 respondents observed problems with physician behavior on a regular basis. One survey respondent summed up the situation in this way: “Some people never reach adulthood. Unfortunately, many of them are physicians who, when under stress, behave as adolescents.”

Addressing the Problem

So what do you do when one of those overgrown adolescents is disrupting your team? All too often, senior leaders just ignore the behavior, hoping it will go away. “Often, these antics come from a very small group of individuals, usually senior-most individuals who have been rainmakers and have gotten into this position because we’ve tolerated it for ill-advised reasons,” said Anthony Whittemore, MD, chief medical officer at Brigham and Women’s Hospital in Boston, who was instrumental in creating the hospital’s professionalism program. “Some are generating huge revenue streams, so everyone says, ‘Oh, that’s just old George, he’s that way,’ and tolerates it. But it’s totally unacceptable.”

Gerald Healy, MD, FACS, past president of the American College of Surgeons, said the issue sometimes boils down to economics. “I think many hospitals in the country are making the mistake of heading in the direction of American business: What’s good for the bottom line? If that means a high-performing, very busy physician who happens to be a disruptive character who abuses people, yells and screams and throws instruments, we find a way to make an excuse for that behavior,” he said. “Even though most hospitals claim to have rules and regulations in place to inhibit that behavior, when you drill down under the surface, I think you’ll find that a lot don’t enforce them very well.”

A Multi-Step Response

Dr. Whittemore said that in the course of his 10 years as CMO at Brigham and Women’s Hospital, he’s come across “no more than a handful of truly disruptive individuals.” Dr. Healy noted that in the current high-pressure environment for physicians, however, disruptive behavior may be on the rise despite attempts to change the culture of medicine. “Doctors are under enormous stress these days. You need to see more patients, and reimbursements are going down,” he said.