The worker, according to court documents, felt threatened: His superior came at him “with clenched fists, piercing eyes, beet-red face, popping veins, and screaming and swearing.” He thought he was about to be hit. Instead, his angry co-worker stormed out of the room.
But it wasn’t just any room: It was in a hospital, adjacent to a surgical area. The screamer was a cardiac surgeon, and the threatened employee was a perfusionist, a person who operates a heart/lung machine during open heart surgery. In 2008, the Indiana Supreme Court ruling inRaess v. Doescher upheld a $325,000 settlement for the perfusionist, who said he was traumatized.
It’s enough to make any patient wonder: Just how well does my health care team get along?
The question is worth pondering, say experts in what is commonly called “disruptive behavior.” Every workplace, like every schoolyard, has its bullies. But when the workplace is a doctor’s office, hospital room or surgical suite — when doctors throw charts at nurses or nurses throw insults at trainees — it isn’t just a workplace problem. It’s a patient-safety issue, these experts say.
“The impact in health care is significant because you are dealing with patients’ lives,” says Peter Angood, CEO of the American College of Physician Executives in Tampa.
Health executives have paid increasing attention to the problem since 2009, when the Joint Commission, which accredits hospitals and other health care organizations, published standards on preventing and dealing with what it calls “behaviors that undermine a culture of safety.” The commission says such “intimidating and disruptive behaviors” can include “verbal outbursts and physical threats,” but also can include using a condescending tone or refusing to answer questions or perform duties. Co-workers or patients may be on the receiving end.
But no matter who is the immediate victim, “most organizations are beginning to understand that this is about patient safety,” says Marty Martin, a psychologist based at DePaul University in Chicago. He co-wrote a guide book, Taming Disruptive Behavior recently published by the physician executive group. The book details growing evidence linking bad behavior with patient harm.
For example, in one survey of more than 4,500 health care workers, 77% reported disruptive behavior by doctors and 65% reported it among nurses. More than two-thirds said such behaviors led to medical errors; nearly one-third said they contributed to patient deaths. A smaller West Coast survey of labor and delivery nurse managers found disruptive behaviors were widespread and had contributed to “near-misses and adverse occurrences.”
The link between bullying and medical mistakes lies in human nature, Martin says. “Say, for example, you are going to get a colonoscopy. You are now sedated, and you don’t know what’s going on. Now let’s say the gastroenterologist and the nurse get into a verbal conflict. One or both of them is likely to be distracted.” If you end up with a perforated colon, he says, it may be because of that distraction, rather than any lack of medical skill.
Various studies based on staff reports and patient complaints suggest 3% to 5% of physicians are disruptive, according to a report in the Annals of Internal Medicine in 2006. Studies also have found that 5% of physicians in any health care organization account for more than a third of complaints from patients and for 40% of malpractice claims, says Gerald Hickson, director of the Center for Patient and Professional Advocacy at Vanderbilt University Medical Center in Nashville.
Many such physicians will improve after some basic counseling from their peers, Hickson says. But a few need a formal intervention program. A model “distressed physicians” program launched at Vanderbilt in 2004 has been reproduced at several other centers. More than half of physicians who attend them return to work, Hickson says.
William Swiggart, a therapist who co-directs Vanderbilt’s intervention program, says: “Sometimes when a physician stays in an institution, that’s a success. Sometimes when he leaves it’s a success.”
Swiggart says at least 80% of physicians sent to the program are male, and a majority are surgeons. They often are highly competitive perfectionists, he says, who see themselves as having high standards and looking out for patients.
“Often their patients love them, but the staff hates them,” he says. Sometimes, he adds, it’s the other way around.
Patients who experience or witness boorish behavior have every right to speak up, Martin says, because the quality of their medical care may depend upon it.
He suggests going to hospital or clinic administrators and “sharing what you observed and how it made you feel.” If you plan to switch doctors or take other action, let them know that, too, he suggests.
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