Many physicians routinely witness disruptive behavior in colleagues

More than 70% of doctors in a recent survey said disruptive physician behavior occurs at least once a month at their institutions. Eleven percent of respondents said it happens on a daily basis.

Factors such as career burnout, heavy workload, marriage troubles or a diagnosable psychiatric illness may contribute to the behavior. Regardless of the cause, experts say physicians and institutions should address inappropriate actions head-on. If left unchecked, such behaviors can create hostile work environments and negatively affect patient care.

"Disruptive behavior is a serious problem," said Bill Norcross, MD, professor of family medicine and director of the Physician Assessment and Clinical Education Program at the University of California, San Diego. "It does bad things to communication and all of us have seen mistakes -- and sometimes fatal mistakes -- happen to patients as a result."

Too often such behavior is tolerated and has been for many years, Barry Silbaugh, MD, CEO of the American College of Physician Executives said in a statement.

Seventy-seven percent of 840 physicians surveyed said they are concerned about disruptive physician behavior at their institutions, according to a report released May 25 by the ACPE and QuantiaMD, a company offering online physician education services that will soon offer a certificate in overcoming disruptive behavior.

Ninety-nine percent of survey respondents said disruptive behavior affects patient care.

"We want to see physicians lead culture change in health care, so that intimidating behavior is not tolerated anywhere in the organization," Dr. Silbaugh said.

Troubling results

The survey used a broad definition of disruptive behavior, including insults, discriminatory behavior, substance abuse, incompetence, physical assault, profanity, spreading of malicious rumors, throwing objects and yelling.

More than half of physicians surveyed said the behaviors they witness most and are most concerned about were doctors making degrading comments or insults, refusing to cooperate with other medical professionals, or refusing to follow established protocols.

While it's a small study, the numbers are troubling, said Humayun J. Chaudhry, DO, president and CEO of the Federation of State Medical Boards.

Sixty percent of respondents said their organization had received a written complaint from a patient or family member about a physician's disruptive behavior, and 21% said they have seen such behavior contribute to an adverse clinical event.

There are multiple ways to address disruptive behavior in physicians. For institutions, it's important to have policies that provide a stepped approach with consequences increasing based on the severity and frequency of the behavior, said Warren Pendergast, MD, president-elect of the Federation of State Physician Health Programs.

Physicians who witness such behaviors should pull their colleague aside, tell them their behavior is inappropriate and help them figure out the reasons for their actions and what they can do differently, he said.

But physicians are often reluctant to confront colleagues, said Barbara Linney, ACPE vice president of career development. Almost a quarter of survey respondents said they did not feel comfortable directly confronting colleagues or dealing with disruptive behavior. "It is very difficult for anyone to deal with someone who is screaming or yelling or throwing things," Linney said.

In instances where bad behavior has been tolerated for many years, institutions also need to address their own need for cultural change, said Charles Meredith, MD, interim medical director of the Washington Physicians Health Program.

In more egregious cases, or instances in which the behavior has continued despite repeated attempts to intervene, an institution may choose to notify the state medical board, Dr. Chaudhry said.

Regardless of how institutions approach disruptive behavior, it's important that physicians have the right to stand up for themselves. "We believe in due process and we want to make sure that we give the individual the opportunity to defend themselves," Dr. Chaudhry said.

The AMA developed a policy model that calls for distinguishing between good-faith criticisms and actions that truly rise to the level of disruptive behavior, and for implementing fair medical staff review processes.