Bad doctors lose patients they shouldn’t, cause avoidable complications, distract team members who may deliver the wrong medication, or cause others to keep quiet when they should speak up about problems. I’m not talking about physicians who lack clinical skills, though some may. Rather, these bad docs may have great and even extraordinary talents. But they scream, berate, physically intrude, threaten, and demean team members – including other physicians, nurses, and other professionals – so abusively and repetitively that patient care may suffer as much as from acts of technical incompetence. You find them in hospitals around the United States. I’ve met many and heard, read, and written about them for more than 20 years. And they are still around, a hardy but generally small group. Their outrageous acts are legendary, causing long-term problems that administrative and medical leaders ignore until some grotesque catastrophe causes them to act, after avoidable damage has sadly already occurred.
Here’s a list of bad behaviors. Physicians (and any professionals and colleagues for that matter) should not do the following:
- Yell, swear at, or insult colleagues.
- Use body language and tones of voice that are intimidating or demeaning.
Lie or falsify information. - Engage in unnecessary or unwelcome physical contact.
- Tell racial, sexual, religious, ethnic, or similar jokes or make related comments.
- Interrupt others who are raising issues and prevent questions or concerns from being asked, or act against those who do so.
On the other hand, physicians should apologize if they behave in any of these ways, and they should give direct constructive feedback privately.
Several of my colleagues – including two highly skilled human resource professionals and a talented risk manager with legal training and experience – and I made this list at lunch in five minutes last week. Avoiding the above behaviors won’t solve every performance concern, but it will go a long way to reducing patient harm, needless errors, and lawsuits that arise from disruptive misconduct. What’s it take to end outrageous behavior? Not policies and values—most institutions already have them in place. It takes leadership commitment, resolve, and action. And the focus needs to be on corralling grossly abusive acts and patterns of behavior as the key priorities.
I’ve seen physician leaders and administrators agonize over what needs to be said and how to stop grievous offenders. Long-term cultural standards of letting docs be docs and fear of losing revenue and talent prevent leaders from looking at such behavior for what it is – avoidable risk that needs to be aggressively managed. Why invest millions in new equipment, medical records systems, or other life-saving technologies when reigning in a few rogues can be done for nothing? And starting from the moment they practice, why not teach all physicians and professionals proper standards of daily conduct through specific learning and daily examples? It’s being done – just not enough.
