The nurse was assigned to the operating room only because more experienced workers had called in sick (as often happened when Dr. G. was scheduled to operate). The nurse's mistake: arranging instruments the usual way—not his way. "You f---ing incompetent!" the surgeon screamed. "I'll have you fired!"
Once, arrogant doctors were simply tolerated. But today's healers from hell, their pedestals crumbling, are seen as a problem in urgent need of solution. When surveyed by the American College of Physician Executives, one-third of administrators reported disruptive incidents among their colleagues at least once a month at their clinics and hospitals. Typical targets: nurses, physician assistants, and other support personnel. And it's too costly to keep replacing them.
It's unclear whether M.D. meltdown has increased in recent years, but Timothy Keogh, a health care management professor at Tulane University in New Orleans, thinks so, citing stressors like rising patient loads, declining reimbursement and the pressure-cooker ambience of operating and emergency rooms.
"These doctors are taking their stress and flinging it onto others," says Larry Harmon, codirector of the Miami-based Physicians Development Program, perhaps the first program anywhere to target this kind of medical misconduct. Terrorizing physicians cause workplace-wide stress that saps morale and can undermine patient care.
Some 70 percent of administrators say problem behavior repeatedly involves the same few doctors. And although most hospitals have a written code of behavior and a formal disciplinary process, few have programs to help doctors reform. By the time a doctor reaches the Miami program—participants come from as far away as Missouri and Massachusetts—airborne charts and scalpels, sarcasm, invective and general disrespect have frequently led hospitals to "get better or get out" desperation.
By and large, these are skillful, productive doctors who are assets to their hospitals, says program cofounder Eva Ritvo, chair of psychiatry at Mt. Sinai Medical Center in Miami Beach. Indeed, coworkers complain that the more valuable a physician, the less he is held accountable for his workplace antics. The good news is that few have substance-abuse problems or psychiatric diagnoses besides (predictably) personality disorders, says Ritvo. "Usually, they're markedly cooperative."
Many participants enroll in a one- to three-day workshop that uses coworker surveys, videotapes and role-playing to foster conflict resolution, anger reduction, and interpersonal skills. "We may train them to do things like limit a reprimand to 30 seconds and follow it with praise, and to express frustration in more constructive ways," Harmon says.
The training provides tools for change, but motivation comes from monitoring (surveys are repeated every three months), which Harmon compares to driving when you know a roadside radar is on. Among participants thus far, dropouts have been few, coworker conduct ratings have improved by more than 50 percent on average and the most serious incidents have largely stopped.
Insight and feedback are key: The doctor and those who work with him complete a survey that details the impact of his behavior. They conclude with comments that can touch the heart of the most irascible surgeon. "'Stop making me go home in tears,' 'I'm thinking of leaving the hospital because of you,' 'Working with you has been so stressful that my husband has left me'—when doctors read that, it's a moment of truth," Harmon says. "They suddenly get it."
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