Re: Arrogant, Abusive and Disruptive — and a Doctor

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I once worked around a doctor who had an overblown ego. He came roaring to the nursing station one day yelling about the terrible nursing care his patient was getting because the patient had developed a wound infection. Never mind that he would not allow the nurses to change the patient's dressings. He was yelling and screaming at me. I stood up and said, "Please, doctor, do not talk to me like that." He demanded I phone the nursing supervisor so he could tell her how rude I had been to him. I quietly handed him the phone and told him the extension to dial. He backed down. He and I never spoke to each other again, but I felt it was no loss for me.

Do one thing every day that scares you.

Eleanor Roosevelt

From: <rumjal@...>Subject: [Flu] Arrogant, Abusive and Disruptive — and a DoctorFlu Date: Tuesday, December 2, 2008, 5:37 AM

Arrogant, Abusive and Disruptive — and a Doctor By LAURIE TARKANIt was the middle of the night, and Silverthorn, a nurse at ahospital in Washington, knew her patient was in danger.The boy had a shunt in his brain to drain fluid, but he was vomitingand had an extreme headache, two signs that the shunt was blocked andfluid was building up. When she paged the on-call resident, who wasasleep in the hospital, he told her not to worry.After a second page, Ms. Silverthorn said, "he became arrogant andsaid, `You don't know what to look for — you're not a doctor.' "He ignored her third page, and after another harrowing hour she calledthe attending physician at home. The child was rushed into surgery."He could have died or had serious brain injury," Ms. Silverthornsaid, "but I was treated like a pest for calling in the middle of thenight."Her experience is borne out by

surveys of hospital staff members, whoblame badly behaved doctors for low morale, stress and high turnover.(Ms. Silverthorn said she had been brought to tears so many times thatshe was trying to start her own business and leave nursing.)Recent studies suggest that such behavior contributes to medicalmistakes, preventable complications and even death."It is the health care equivalent of road rage," said Dr. B.Angood, chief patient safety officer at the Joint Commission, thenation's leading independent hospital accreditation agency.A survey of health care workers at 102 nonprofit hospitals from 2004to 2007 found that 67 percent of respondents said they thought therewas a link between disruptive behavior and medical mistakes, and 18percent said they knew of a mistake that occurred because of anobnoxious doctor. (The author was Dr. Alan Rosenstein, medicaldirector for the West Coast

region of VHA Inc., an alliance ofnonprofit hospitals.)Another survey by the Institute for Safe Medication Practices, anonprofit organization, found that 40 percent of hospital staffmembers reported having been so intimidated by a doctor that they didnot share their concerns about orders for medication that appeared tobe incorrect. As a result, 7 percent said they contributed to amedication error.There are signs, however, that such abusive behavior is less likely tobe tolerated. Physicians and nurses say they have seen less of it inthe past 5 or 10 years, though it is still a major problem, and theJoint Commission is requiring hospitals to have a written code ofconduct and a process for enforcing it.Still, every nurse has a story about obnoxious doctors. A few say theyhave ducked scalpels thrown across the operating room by angrysurgeons. More frequently, though, they are belittled,

insulted oryelled at — often in front of patients and other staff members — andmade to feel like the bottom of the food chain. A third of the nursesin Dr. Rosenstein's study were aware of a nurse who had left ahospital because of a disruptive physician."The job is tough enough without having to prepare yourselfpsychologically for a call that you know could very well becomeabusive," said J. Mason, editor in chief of The American Journalof Nursing. Sweet, deputy chief of enforcement at the Medical Board ofCalifornia, described the case of a resident at a University ofCalifornia hospital who noticed a problem with a fetal monitoringstrip on a woman in labor, but didn't call anyone."He was afraid to contact the attending physician, who was notoriousfor yelling and ridiculing the residents," Ms. Sweet said. The baby died.Of course, most doctors do not spew insults or

intimidate nurses."Most people are trying to do the best job they can under ahigh-pressure situation," said Dr. ph M. Heyman, chairman of thetrustees of the American Medical Association.Dr. A. Norcross, director of a program at the University ofCalifornia, San Diego, that offers anger management for physicians,agreed. But he added, "About 3 to 4 percent of doctors are disruptive,but that's a big number, and they really gum up the works." Expertssay the leading offenders are specialists in high-pressure fields likeneurosurgery, orthopedics and cardiology.In one instance witnessed by Dr. Angood of the Joint Commission, anurse called a surgeon to come and verify his next surgical patientand to mark the spot where the operation would be done. The harriedsurgeon yelled at the nurse to get the patient ready herself. When heshowed up late to the operating room, he did not realize the

surgerysite was mismarked and operated on the wrong part."The surgeon then berated the entire team for their error andcontinued to denigrate them to others, when the error was thesurgeon's because he failed to cooperate in the process," Dr. Angood said.A hostile environment erodes cooperation and a sense of commitment tohigh-quality care, Dr. Angood said, and that increases the risk ofmedical errors."When the wrong surgery is done on patients," he said, "often there issomebody in that operating room who knew the event was going to occurwho did not feel empowered enough to speak up about it."Dr. Norcross blamed "the brutal training surgeons get, the long hours,being belittled and `pimped' " — a term for being bombarded withquestions to the point of looking stupid. "That whole structureteaches a disruptive behavior," he said.Dr. Norcross and other experts said staff members'

understandablereluctance to challenge a physician, especially a popular surgeon whoattracts patients to the hospital, created an atmosphere of toleranceand indifference. So did a tendency among doctors to form "old boy"networks and protect one another from criticism.But things have begun to change. Today, good communication andleadership are two of the six core skills taught in medical schoolsand residency programs. More nurses are challenging doctors on theirinappropriate behavior, and fewer hospitals are tolerating disruptivedoctors. "Today they're getting rid of that doctor or sending them toanger management," said Dr. R. , executive director ofthe American College of Surgeons.Hospitals have also developed more formal and consistent ways ofaddressing disruptive behavior, Dr. Rosenstein said. They are alsotrying to improve relations and mutual respect between doctors and

nurses.At Muir Health, a nonprofit group of two hospitals in WalnutCreek and Concord, Calif., a committee of physicians, nurses and otherstaff members was formed to focus on collaboration and communicationbetween disciplines."When complaints are submitted, we try to be proactive early to letthem know there is not going to be any tolerance for that," said Dr.Roy Kaplan, Muir's medical director for quality.Some physicians worry that hospital administrators will abuse thestricter codes of conduct by using them to get rid of doctors whospeak out against hospital policies. And the Joint Commission rulingshave spawned a cottage industry of anger management centers and lawfirms defending hospitals or physicians.Professionals like Ms. Silverthorn, the nurse in Washington, said thechange was overdue."We go to school, we have a very important job, but there's norespect,"

she said.She recalled a particularly humiliating moment on Dec. 25, 2006.Working in the pediatric emergency room, she called a drug by itsgeneric name rather than its brand name."I was quickly shouted out of the trauma room and humiliated in frontof everyone," she said. But while "everyone knew the doctor wasactually the one who didn't know what he was doing," she continued, noone said a word.http://www.nytimes. com/2008/ 12/02/health/ 02rage.html