Blaming the disruptive doctor ignores the causes of physician frustration

Regarding "Staff less tolerant of rude doctors" (Article, Sept. 20): Your article failed to probe the underlying frustrations that provoke "disruptive" physician behavior. Apart from hospitals tolerating such abusive behavior, hospital deficiencies are directly responsible for provoking this type of conduct. Blaming disruptive doctors is only a smokescreen.

Growing public distrust of the integrity of our health care system is partially attributable to a perceived reduction in the quality of hospital care. This has generated numerous patient safety laws steadily emerging from state and federal legislatures. Lack of public confidence may be responsible for the high number of malpractice lawsuits, suggesting that the public feels that their ultimate redress lies within the court system.

Increasingly marginalized, physicians are unable to verbalize their dissatisfaction with their patient's care and often feel that their criticisms are largely ignored by hospitals. Perhaps most galling is that physicians continue to be held to the highest standards while hospital standards have deteriorated. In most cases, it is rare to find a nurse, let alone a knowledgeable nurse, who is capable of discussing a patient's condition. This leads to the most substantial deficiency in hospital care: the availability and quality of proficient nurses.

The main challenge to the profession is the reality that American medicine has been taken over by corporations driven by corporate concern for profits and market share. Administrators find it easier to deal with bricks, mortar and advertising campaigns than develop a true understanding of their fundamental objective: Heal the patient. Rarely do they venture beyond their offices. If one assumes that nurses and technicians are the hospital, then hospitals will have to begin by improving the quantity and quality of their personnel. Hospital priorities seem to have become perverted.

Ideally, physicians should stand as patients' advocates. Yet we physicians are hesitant to assume that role when we find ourselves increasingly repudiated for criticizing hospital care. If patient care is the essence of what we doctors do, what is our responsibility when hospital deficiencies jeopardize our patient's life? If hospitals are truly desirous of correcting physician behavior, they will have to begin by improving care. Our fundamental obligation is to the patient.

Arthur E. Palamara, MD, Hollywood, Fla.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/11/22/edlt1122.htm.