Daniel Freedman, DO, a pediatric neurologist in Austin, Texas, remembers being startled when a surgeon threw an instrument into a medical school room.
“It’s unbelievable that a grown man in his 50s is throwing a tantrum,” Friedman said. Medscape Medical NewsBut that wasn’t the last time I witnessed a co-worker’s bad behavior.
As a result of a recent report from Medscape, Physician Misbehavior: Stress and Distress Lead to Misconduct, It suggests that he has a lot of company.More than 4 out of 10 (41%) of his respondents observed Inappropriate behavior at work In 2022, that will increase from 35% in 2021, according to a report that surveyed more than 1,500 doctors about inappropriate behavior around the clock.
Of course, 38% of respondents have never seen a case of fraud. And many of the cases seen were mild or rare.In addition, cases of bad behavior have declined significantly over the past five years.
Friedman says the lessons he learned from his mentor and program director during his training have stuck with him throughout his career. “If you can’t behave that way in any job, whether it’s McDonald’s or any other possible place, then you shouldn’t behave that way in medicine. “Many of the badly behaved people may not have worked in a different environment before,” he said.
“They only perceive themselves to be at the top of the food chain, so they can act unaffected and do bad things.”
According to Charles Samenow, M.D., associate professor of psychiatry and behavioral sciences at George Washington University, who has studied the phenomenon for many years, what Friedman described is the definition of several categories of inappropriate behavior in medicine. One, formally called destructive doctor behavior.
“Doctors’ disruptive behavior compromises workplace safety,” Samenow explained. This behavior can occur at work, outside of work, or on social media. It can interfere with surgery, threaten patient and staff safety, and affect workplace morale.
“The problem is trying to understand where that bad behavior comes from and the impact of that bad behavior,” Samenow told Medscape.
One reason is very simple. Doctors are humans, and humans behave differently. Additionally, tension, stress, danger, burnout, and other issues during COVID have left many doctors feeling tired, frustrated, depressed, and more sensitive to their surroundings, as a Medscape study showed. increase.
The self-selection trait becomes the Achilles heel
“Humans placed in positions of power over other humans may be destructive, harassing, etc., if they possess certain personality traits.” David Gorsky, M.D.A professor of surgery at Wayne State University School of Medicine said: This is consistent with Samenow’s research.
Classical destructive behavior is usually not associated depression, manic, psychotic, or similar traits, explains Samenow. Rather, it tends to depend on personality. “Doctors are not immune to the usual problems that all humans face,” he says.
A Medscape report cited personal arrogance (56%) as one of the top reasons doctors behaved inappropriately, followed by personal issues outside of work (52%), and more casual behavior. Societal changes (50%) that have become more accepting of behaviors continue. Work-related stress (46%). (Respondents can select multiple answers).
One of the contributing factors to cheating that Samenow consistently identifies in his research is a history of adverse childhood experiences and family dysfunction. People who grew up with physical or verbal abuse learned anger as a coping skill rather than as an aggressive, assertive communication. As such, some doctors, like the general population, may have learned anger as a coping skill.
How to avoid disruptive behavior in medical settings
Samenow says coaching is a “great tool” for teaching interpersonal skills that are often not covered in medical school.
Intervention can be very helpful in some cases. For example, programs that combine culturally sensitive dialectics, cognitive-behavioral therapy, and other modalities to teach effective communication strategies and teamwork are successful, says Samenow. Although they focus more on treating disease than on dealing with “cheating”, programs for substance use developed by and for doctors are also very effective. .
But there are limited resources available to address racism, classism, misogyny, and other forms of prejudice, Samenow said. “There is implicit bias training, but it’s not at a level that exists for disruptive doctors and patients.” Addiction“That’s an area we need to work on.” Racist language was the third most commonly observed mention in the Medscape survey, behind staff bullying and patient ridicule or disrespect. It was bad behavior. Outside of work, he was often in the news.
The Medscape report found an increase in observed behavior in the workplace and on social media, but it’s difficult to determine trends in prevalence over time, Samenow said. There are likely to be more reports because “tolerance for this behavior has really gone down,” he said, and there are more systems in place for reporting bad behavior today than there used to be.
But Friedman said inadequate regulation, disciplinary action and follow-through remain problems.
“There are many limitations to our reporting system and the follow-through of those reports.” For example, hospitals that allow doctors to quietly resign and move to another facility even with positive recommendations, for fear of lawsuits or other reasons. Friedman said.
In fact, only one-third of the frauds observed in Medscape’s reports resulted in disciplinary action. Half of respondents believe a verbal warning is a necessary outcome, followed by a conversation with management and being reported to their manager or HR. Only 10% of them thought reporting to the medical board was warranted, but that could depend on the crime and its frequency.
“I think moving from paternalism to more patient-centered care and having patients participate in such conversations is a wonderful change that makes doctors more human and approachable. I hope the public will be more tolerant of making mistakes and that no one is perfect,” Friedman said. But if one or two mistakes become a pattern, doctors should be held accountable, he added.
Misinformation is Professional Misconduct
These doctors say there is a particular lack of full accountability for the spread of misinformation that is part of professional misconduct.
The more “traditional” bad behavior includes fraud, dishonesty, subordinate abuse, and incompetence, but bad behavior should also include “cheating and selling misinformation against vaccination.” Yes, Gorski frequently blogs about doctors spreading misinformation.
Taylor Nichols, M.D., a Sacramento-based emergency medicine physician, cites the desire for attention and influence as motivations. Nicholls said, “It is professional misconduct to say something that is exaggerated and clearly wrong. He does not consider such statements to be of the scientific, academic, or clinical opinion required in medicine.” Differentiated and distinguished.
Still, there is a “long tradition of looking the other way and allowing people with fancy titles to say nonsense just because they are respected.” Jonathan Howard, M.D.an associate professor of psychiatry and neurology at New York University’s Grossman School of Medicine, told Medscape.
“We have a duty to be trusted members of our community,” Howard said. “People listen when we say things. We have a duty to be accurate, humble, and as honest as possible, and to admit when we make mistakes that are inevitable.”
That has also extended to social media, which Nichols said magnifies the problem of promoting phony and misinformation. He said medical commissions and professional accreditation bodies need to pay attention to what is happening in the public discourse and understand that our professional responsibilities extend beyond the walls of hospitals and clinics. Physicians must represent themselves professionally and uphold the standards expected of the profession.
On the one hand, Medscape respondents agree, with 70% saying that one doctor’s misconduct taints the entire profession. But at the same time, 58% of respondents believe doctors should be able to “keep their personal lives private” by 2022. Said.
“The way doctors behave in public describes you,” he said. “What happens in Vegas doesn’t always stay in Vegas….”
Tara Haelle is a Dallas-based health and science journalist.follow her @tarahaelle.
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