A physician's rebuke over poor work can be painted as disruptive behavior

LETTER — Posted June 6, 2005

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Regarding "Bully case verdict a warning to doctors" (Article, April 18), "Abusive behavior test: Would you say same thing to a subordinate if that person's spouse was present?" and "When judging physician bullying, consider what would have happened if the aggressor were a nurse" (Letters, May 9):

The letters on abusive behavior give an impression that bullying and disruptive behavior in hospitals are mostly caused by physicians. This is a very false picture.

Disruptive behaviors in medical settings are usually a complex cascading phenomena and overwhelmingly the end point of inadequate and poor quality work on the part of support staff. There is far more resistance to carry through doctors' orders and more passive-aggressive petty mischief on part of ancillary staff toward patients and doctors than our political correctness is willing to admit.

The doctor has little incentive to respond in the same fashion, being primarily responsible for the medical outcome, having higher personal liability if the care goes awry, and generally having higher educational, intellectual and ethical standards. His direct and enforcing behavior, which occasionally escalates into lashing out with indignation, is easily ratcheted up as disruptive behavior.

All across the hospital I see doctors walking on eggshells, not sure when the other shoe is going to fall.

Surendra Kelwala, MD, Livonia, Mich.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/06/06/edlt0606.htm.

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