Wednesday, June 20, 2012

Unprofessional behavior by medical hospitalists

By their own admission, medical hospitalists are guilty of many types of unprofessional behavior says a recent paper published ahead of print in the Journal of Hospital Medicine. A group of researchers from the University of Chicago surveyed medical hospitalists from three major Chicago area teaching institutions. The respondents themselves rated each listed behavior on a professionalism scale. There were 77 responses from pool of 101 hospitalists who were sent the questionnaires. The study asked respondents to state whether they had either engaged in and/or observed unprofessional conduct.

The key findings were as follows:
  • Most of the respondents had engaged in at least one unprofessional behavior.
  • The most common unprofessional behavior was [I hope you are sitting down.] having non-medical/personal conversations, such as discussing plans for the evening, in hospital corridors. [Gasp!]
  • Over 60% of these doctors admitted that they ordered a routine test as “urgent” as a way of obtaining results more quickly. [Can you believe it?]
  • My favorite is that 40% confessed that they had made fun of or disparaged the emergency department team for missing findings. [Unreported but very likely true is that 60% of those questioned committed another unprofessional act, which was lying by claiming they had never made fun of or disparaged any ED MDs. The only physicians I know who do not routinely make fun of the ED staff are pathologists because they never deal directly with the ED. Before all you ED docs get your panties in a knot, I am certain all of you disparage all of us too.]
  • Other alleged unprofessional behaviors were celebrating a blocked admission, going to working when ill and texting during conferences.
Another interesting finding was that for every one of the over 30 unprofessional behaviors listed in the questionnaire, hospitalists said they had observed many more such behaviors than they admitted to participating in.

Despite what many surgeons may have believed, this survey shows that medical hospitalists are really pretty normal. 

But I suspect there will be corrective actions for these doctors at the three hospitals. A curriculum will be developed and monitoring metrics will be established. Maybe listening devices will be placed in hallways. These scandalous behaviors must be stopped.

A final note—this study was supported by grants from two different sources.

17 comments:

Roger said...

Were the grants from companies that develop listening devices?

Leo said...

Ugh, I find it sad that reputable schools with reputable researchers get grants for ridiculous research projects which eventually get published in well known journals. On the other hand you have struggling researchers who are good, with great research ideas at so so schools who cannot find the funding or get their published in well known journals

Skeptical Scalpel said...

Roger and Leo, thanks for commenting.

Roger, the research was funded by the ABIM {American Board of Internal Medicine] Foundation and the Pritzker Summer Research Program, but I can see how you might have assumed it was by companies that make listening devices.

Although I agree with the essence of Leo's comment, I'm not sure the Journal of Hospital Medicine [Impact Factor 1.95] is a well-known journal.

Anonymous said...

Going to work when sick. What were they thinking? I'm sure finding someone to fill in would not present a problem. Don't they get 20 or 30 sick days?

Skeptical Scalpel said...

Anonymous, thanks. They're too busy discussing personal matters at work to risk missing a day.

Anonymous said...

I would like to do a study like this in the ER. I think it would show that

100% of ER docs admitted to

- ordering expensive studies without ever seeing a patient
- calling a consult without an actual diagnosis just hoping the consultant would admit a patient
- not being able to find the OR or ICU in their own hospital
- not being able to locate the spleen on an abdominal ct scan

jennifer downs said...

silly question, as am not from the states. what's a hospitalist?

Skeptical Scalpel said...

Anonymous, thanks and I understand why you chose to be anonymous. You raise some interesting points.

Jennifer, no question is silly if you don't know the answer. There are probably others who don't know what a hospitalist is but were too timid to ask. Paste this link, http://en.wikipedia.org/wiki/Hospital_medicine, into your browser.

MD aware said...

I don't want my tone to be misconstrued -- this is all in good fun! but don't worry, we in the ED know that the upstairs folk make fun of us, and I admit that we disparage other specialties as well. my favorite are the layered disparagements, e.g: "the ER is silly for never giving lasix to CHF patients!" vs. "those hospitalists always make fun of us for never giving diuresing APE pts when we know that doesnt help and usually hurts!"

in all seriousness, I think a lot of the rancor, particularly in academics, is that the admitting residents don't get any "incentive" to admit; it's just one more patient from the ED (i.e. they don't get paid more for another patient). further, esp with surgical (of all stripes) patients, it's a needle vs haystack problem. the surgical resident never sees the patient with the normal RUQ US because the patient went home. the patient with clear cholecystitis is quick & easy. but the ones that rankle everyone are the patient with a small stone, maybe a thick wall, no pericholecystic fluid, tenderness but not too bad... it takes all day to figure out which way the patient goes and it's really just an unclear patient.

ampace said...

As an incoming M1, I find the bickering between specialists a little disheartening. Does this lead to some sort of passive aggressive mistrust between specialists or is it reserved for happy hour and blogs?

Skeptical Scalpel said...

MD Aware, Thanks for admitting that it goes both ways. I agree with you that there is no real incentive for residents to admit, especially if it's not an interesting patient. But paying them to admit is likely to lead to a lot of unnecessary and unjustifiable admissions.

I also agree that the borderline cases, like right lower quadrant abd pain with an equivocal CT scan, are the tough ones.

MD aware said...

not just tough cases, they're the ones we remember! no one remembers the slam-dunk appy...

Skeptical Scalpel said...

Ampace, I'm afraid at times the mistrust is real.

suzanne smith said...

I have docs in the ER that mark labs as urgent...um really we are in an ER...ya think?

Skeptical Scalpel said...

Suzanne, I have a theory that the lab does whatever it wants regardless of how you mark the specimens. The fact is, the new auto-analyzers most labs have can run any test in 5 to 10 minutes, yet it still takes an hour to get a stat lab result back.

Bob said...

Running the test is only a small part of the Turn Around Time (TAT).
Add in the amount of time it takes for the secretary to put in the order, the phleb then waits for Xray to get their fourth film. The nurse then tells the phleb that she will draw the blood they need when she starts the IV, right after she does something quick with another patient.... 10 min later.
Turns out that the patient is on Coumadin, and it takes 15 for the blood to clot. Finally spun, and run thru the 15 parameter analyzer, and the Coumadin rich plasma (that was thought to be serum) decides to clot in the analysis path, requiring a 15 minute tear down, and re-riming the clot.
If the er system is not down, the result is then picked up by the nurse, who was on another of her 10 minute jobs, and brought to you.
While every source of pre and post analytic frustration is not present on every specimen, there's usually at least one on most of them.
BTW.. We also make fun of you because you gripe about it taking an hour for lab results when it takes you four hours to discharge the patient..... ;-P

Skeptical Scalpel said...

Bob, good to hear another point of view. I hate Coumadin too.

Post a Comment