Arrogant and Abusive Doctors Pose Safety Risks to Patients

From New York Times--December 2, 2008

Nearly every nurse can tell stories about doctors who yelled at them in public, threw scalpels across the operating room, ignored calls to come to a patient’s bedside, or otherwise acted in an arrogant and abusive way. While this behavior used to be tolerated as an inevitable byproduct of working in a high-stress environment, health care leaders are increasingly recognizing that bad behavior can endanger patients’ lives. And they’re taking action. As the New York Times reports, the Joint Commission which accredits hospitals is urging hospitals to send disruptive doctors to anger management classes and to take other steps to curb abusive behavior.

The problem for patients is that for health care to work well, members of the health care team need to be able to communicate freely with each other, without fear of having their heads bitten off by someone with a superior attitude. Surveys have shown time and again that errors such as “wrong site surgery” or medication overdosing happen in part because someone who knew better, but who lacked status in the pecking order, was afraid to speak up — or was ignored when they did.

The Times article reported how one boy with a shunt in his brain almost died because of his on-call resident’s arrogance. The resident dismissed the nurse’s warning each time when she called to inform him that the boy was showing signs that the shunt was blocked, telling her “You don’t know what to look for – you’re not a doctor.” The nurse eventually notified the attending doctor, who operated on the boy immediately and barely prevented brain damage.

At a California hospital, a baby died because the resident who feared the attending doctor, “who was notorious for yelling and ridiculing the residents,” didn’t call him about a problem with a fetal monitoring strip. This resident is only one in many others who don’t feel “empowered enough to speak up” about preventable tragedies that include doing the wrong surgery on patients, says Dr. Angood of the Joint Commission.

While patients are the direct victims of overstressed physicians (especially in neurosurgery, orthopedics and cardiology), nurses often bear the direct brunt of the abuse on a regular basis.

These doctors are a small minority, perhaps 3 to 4 percent of all practicing physicians, according to one doctor who gives anger management classes. But even that is too many.

Disruptive doctors are being challenged by nurses who are backed up by hospital officials, sent to anger management courses, or (eventually) dismissed by the hospitals. Hospitals are also developing ways to cultivate a better working relationship between doctors and nurses.

Disruptive and abusive behaviors create communication barriers that can interfere with diagnosis in addition to causing medical errors. But poor communications can be an issue even when there is no out-and-out abusive behavior. Often doctors just need to slow down and listen to their patients. The Washington Post’s Sandra Boodman writes about a patient saved by a doctor who listened. Carol Welsh didn’t know she had something growing in her head until she saw a doctor who “[took] the time to listen” and figured out that an undiagnosed brain tumor was the cause behind her nausea, vomiting, weight loss and mental fuzziness. Dr. Clifford Henderson saved Welsh’s life by finding the tumor and getting it removed. A few more weeks and she would have died. That there might be a brain tumor did not cross the mind of the previous doctor who treated her for five months.