Friday, May 10, 2013

Anger management for doctors

A recent Washington Post/Kaiser Health News story about anger management led with an anecdote about a surgeon who broke a scrub tech's finger by slamming down an improperly loaded instrument. The surgeon was suspended for two weeks and had to take an anger management course, which seems like a mighty small penalty for what could be described as assault.

But the story had to go where many such tales seem to go these days.

Here's a quote: "Experts estimate that 3 to 5 percent of physicians engage in such behavior, berating nurses who call them in the middle of the night about a patient, flinging scalpels at trainees who aren't moving fast enough, demeaning co-workers they consider incompetent or cutting off patients who ask a lot of questions."

Demeaning co-workers and berating nurses who call in the middle of the night? Yes, these things unfortunately do occur. But "flinging scalpels at trainees"? Sorry, I don't think so. But of course, exaggeration is a common feature of articles about doctors, especially if the story wants to portray us in a negative way.

I was a surgical chairman for many years. I know all about disruptive doctors. In a recent blog, I even admitted to throwing an instrument myself once when I was a young and headstrong resident.

A link in the Washington Post story goes to a full text paper on disruptive behavior in the Journal of Medical Regulation (who knew there was such a journal?). The author points out that isolated episodes of what some might consider bad behavior can happen, but unless there is a pattern or the incident was egregious, doctors should not be labeled as disruptive.

There are many problems with disciplining disruptive physicians. The article addressed a few of them. 

Here are a couple that weren't mentioned. 

The disruptive doctor may be a busy surgeon or big admitter of patients. This puts the hospital in a bind, especially if there are other hospitals nearby. The doctor can and will threaten to take his patients across town. 

Or the bad actor may be the only physician in a critically important specialty on staff. 

These situations give physician miscreants leverage which tends to mitigate the punishment meted out—analogous to the way pampered athletes and movie stars are treated when they commit crimes.

I have first-hand experience with this having dealt with disruptive surgeons in the past. What I wanted to do and what the hospital administration would permit me to do weren't always the same. By the way, behavior modification programs rarely result in permanent cures. A middle-aged surgical ogre is not likely to become Prince Charming after two weeks of anger management.

So the issue is not as straightforward as it seems. 

By the way, just to show how far toward equality we have come, that surgeon who broke the scrub tech's finger was a woman.


Henna said...

When I looked at the article, I was glad to see that it mentioned passive-aggressive behavior too. This is what I see most commonly among nurses, and as the article stated, it is usually directed to other nurses. I disagree, however, that "their [nurses'] behavior is less likely to affect patients." It nearly always affects patients.
Here is an example: a nurse has called down for blood. It comes up from the blood bank. Another nurse sees it, puts it in her pocket, and walks off. It mysteriously reappears just a little too late to hang. The patients ultimately bear the brunt of most of those little maneuvers.
Sometimes I think we should give all the staff Pokemon cards. Then the tantrums could be over who had more and who traded which. That's about the level that most of these interactions reach.

Anonymous said...

As a busy surgeon I've occassionally gotten irritated at poor nurses or doctors and told them about it. The point is to get people to think what they are doing and improve their skills and care. Numerous touchy-feely meetings sometimes don't work.

NeuroTrumpet said...


That behavior from the nurse in your anecdote is egregious and inexcusable. He or she should be fired. Did that example come from your imagination or is it a real life occurrence? They have no business being a nurse, or working in healthcare at all.

Skeptical Scalpel said...

Good comments. I doubt that Henna's colleague was disciplined. Anon is risking being called to the medical director's office for expressing irritation to a nurse about her performance (not so much expressing irritation to another doctor about her performance, unless she was a resident).

Anonymous said...

the problem of this topic is the way the "disruptive physician" title is used to control physicians. If a hospital finds that a doctor does not follow in line they are labeled disuptive then it can destroy a career. This is a dangerous slippery slope that can be used to chase out undesirable doctors or competators

Henna said...

NeuroTrumpet, it's a real occurrence and happened about 2 months ago (not to me). My colleague got off scot free. It's not always easy to fire people. It is easy for the culprit to say something like, "Oh gosh, I'm so sorry, I picked this up to hand to Susie-Q and then xyz happened."
I can confirm that if Anon expressed irritation to a poorly performing nurse, he'd probably be called on the carpet. I've seen that happen to a friend's husband. He had to apologize to the nurse in question. Funnily enough, it actually hadn't bothered her because she knew she had made a mistake. Someone else who overheard the interaction found it offensive (he used bad language) and reported it.

Skeptical Scalpel said...

Anon and Henna, thanks again for the great comments. I agree that calling someone disruptive can be devastating and used for nefarious purposes.

I like it when people who aren't even involved with an argument file a complaint. I suppose the person who complained never swears.

artiger said...

That last paragraph...I can't decide if it's a step forward or backward.

Anonymous said...

I think the OR has its own time-warped culture. Cursing, including the f-word, sexual innuendos, crude jokes, belittling co-workers, are much more frequent and accepted in the OR than on the wards. Yes, surgeons are the most frequent culprits. Of course, in any corporate setting, all this would be verboten.

Skeptical Scalpel said...

Artiger, I 'm not sure either.

Anon, good point. It's hard to disagree with you. I'm not sure how prevalent such goings on are these days, but since you mentioned it, I guess it still happens. I'm not sure why it's tolerated in the OR.

Anonymous said...

This last paragraph IS the grand finale! Awesome!

Skeptical Scalpel said...

Yes, we have reach gender equality. Isn't that great?

Anonymous said...

I had one of those surgeons: in a $$$ subspecialty. He was also labeled as good looking by a lot of the nurses. I had him raise his voice to me a number of times, get irritated with me, and even I told him about showing his ego at times. Not the best communicator either. I've since found out that I'm not the only one who got put with him and didn't want him. He's a good doc but has made a few mistakes. The hospital, of course, is never going to do anything.

I frankly can understand why people sue any more. The medical profession does need to do a better job of policing its own. That's a big reason why there are so many complaints. Favoritism, cronyism, I've seen just about everything. The fact is, a pretty decent doc gets too big for his pants, makes a mistake on someone who is sue happy, and now its a mess for everyone. Had a hospital taken action sooner, or a nurse who wasn't awed by Dr. Cute, that would have happened.

Skeptical Scalpel said...

Anon, those are very good points. It's hard to argue with them.

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