Make it a rule never to be angry at anything a sick man says or does to you.
-Benjamin Rush, MD (1809)
Thirty years ago, I heard dozens of stories about a memorable doctor. His daily outbursts in the hospital were legendary. No one wanted to get in his crosshairs, so people scattered when he was spotted coming down the hall. As soon as he burst into the ICU, it was chaos. Minor bedside procedures always included an extended rant directed at his assistant. He threw instruments, clipboards or charts across the room when answers came too slowly or were not what he wanted. The overworked nurses and young students with whom he interacted were usually close to tears when he finally stormed out. For all of the time I worked in that hospital, his behavior was tolerated. He was a big shot, after all.
Why would any adult treat other people this way? Why didn’t someone do something?
I suspect the doctor justified his behavior by claiming he was only trying to protect his patients from incompetent and lazy help. He probably had been trained by someone who behaved in exactly the same manner. I suspect the hospital leadership had few tools to deal with an otherwise invaluable staff member who had a knack for regularly throwing everything into upheaval.
Many years have passed, and the problem of disruptive doctors has not disappeared. A recent survey of a very small sample of medical leaders indicates badly behaving physicians still exist in hospitals of every size and locale. The most common types of disruptive behavior still include degrading comments, insults, refusal to cooperate with other providers, refusal to follow established protocols, yelling, profanity, inappropriate jokes and incompetence. Throwing objects and physical assaults are rare, but are reported.
Interestingly, about a quarter of the physicians who responded to the survey admitted they had been disruptive at one point in their careers. The most common justifications the physicians cited for their own disruptive behaviors included workload issues and falling back on behaviors learned years before from role models. They also blamed other health care workers, non-work related pressures, hospital policies, the patients or reimbursement issues.
The list of "justifications" is telling — the physicians were routinely able to identify another person or an external source for their behaviors. As my kids sometimes told me years ago, it just wasn’t their fault.
David Brooks, in a recent essay entitled The New Humanism, reminds us we all benefit when we develop characteristics that help us work better in groups. We are our best as human beings when we strive to be closely attuned to each other, see the "big picture" patterns in our worlds, and find ways to work effectively and sympathetically with others. Individuals thrive when we are able to “serenely monitor the movements of one's own mind and correct for biases and shortcomings.” A tall order, but critical in the hospital and clinic, where other people’s lives are in the balance.
As we prepare the next generation of physicians, we pass along medical knowledge and procedural skills, but we must also seek to develop each young doctor's ability to be insightful and compassionate. None of us wants to be remembered like the old, cranky, profane physician I witnessed many years ago who put his patients at risk, all the while thinking he was helping them. It was just plain wrong. We can do better.
The following is feedback received for this blog:
Great article Dr. Campbell! Having worked with you years back I can honestly say you are one of the true Humanitarians yourself! You're time and willingness to "hear" patients sets you apart. You are compassionate and kind. It has been a gift to have had the opportunity to work with you and I'm so proud to know that physicians like you are out there!
- Jane Leuzinger
