Perfectly Obnoxious

"While unprofessional conduct by physicians was never acceptable, it is clearly no longer tolerated in today's health care environment. In the long term, disruptive behaviour can lead to ineffective care, harm to patients and poorer clinical outcomes."
Canadian Medical Protective Association, analysis report
 
"They want to be perfect, they want to get everything right, and someone is saying, 'No, you can't have that CT scan or you can't get into the OR right now' and this can be devastating for these folks.
"They have such high expectations of themselves, they can't accept anything but the best from everyone else."
Dr. Paul Farnan, occupational health consultant, Vancouver

Dr. Farnan's take on the situation, discussed at a special session on disruptive doctors at the Canadian Medical Protective Association's annual meeting was a tad on the forgiving side, generous in its interpretation. Portraying as it does, physicians and surgeons so completely engrossed in their professional care of patients that it is that caring side, when offended, that causes them to go berserk. As in throwing an emotional tantrum, behaving in a disruptive manner, insulting others...?

On the other hand if it seems that those in the medical profession are not all that different in their psychical makeup than any other general members of society, simply that they have chosen medicine as their profession, bringing along with that choice their own personalities which may be abrasive, anti-social or egotistical, it is not really patient care that concerns them and against which they are acting out, but their very own intimate proclivity toward being offensive.

When we are in the direct company of a health professional whose services we require we automatically think we are in the presence of a socially mature, competent, experienced health practitioner, and we surrender our health outcomes to that person's presumed expertise. Because we need to believe that this individual is capable of solving our health problems there is never any question of our going beyond the facade and seeking out the human beneath the professional. And why would we?

Well, we would if we were given reason to. Being treated cavalierly by the health professional would be one reason. Experiencing a relationship bias toward the doctor's casual dismissal of the patient's concerns might be another, if no reasonable evaluation has taken place and follow-up explanation that might satisfy the need of the patient. Or, knowing that the doctor chose not to respond to a situation that seemed serious to the patient.

Like a nurse in attendance at a hospital, noting that a patient's condition is deteriorating, yet hesitating to call the doctor at night to inform of the patient's condition because the doctor reacts very poorly to having his sleep disturbed. According to the Canadian Medical Protective Association, the body whose purpose is to defend doctors accused of malpractice, their case load is growing. Involving doctors against whom allegations of unruly conduct brought against them by their licensing colleges or hospitals, they must respond to.

An analysis of cases brought before the body between 2001 and 2010 indicates that 5% of all college cases and 5% of hospital complaints involved "disruptive behaviour" by doctors. And when those cases were examined and dealt with, the majority resulted in an "unfavourable outcome" for the doctor. In other words charges were not laid without cause. The charges represented in most instances patterns of offensive behaviour, poisoning general health care morale and harming patients' care.

Studies conclude that up to 6% of doctors are responsible for engaging in disruptive behaviour. The offensive behaviour can be reflected in overt bullying, shouting and swearing, throwing objects, demeaning others in front of witnesses, and uncontrolled outbursts of rage, leaving observers feeling nervous and upset. Passive-aggressive attitudes also come under fire; non-response to pages or emails, failure to show up at scheduled meetings and "not behaving as part of the team".

In an American study, 77% of doctors who were surveyed in 2011 claimed to be concerned about the presence of badly behaving doctors at their hospitals. "An overwhelming 99% of doctors believe that disruptive behaviour affects patient care", the paper presented at the CMPA conference stated. "We've seen increasing numbers of cases, and increasing medical-legal costs associated with" doctors behaving badly.

And, um, isn't this also interesting: "But the literature is clear on that: it's generally males", clarified Dr. James Sproule, managing director of physician services at the CMPA. On the empathetic side -- stress, burnout, cynicism, frustration over health-care cuts and other reactive triggers are recognized as exacerbating existing problems. The College of Physicians and Surgeons of Alberta's document produced in 2010 points out that 78% of doctors displaying disruptive behaviour may in fact suffer from a major psychiatric disorder, and up to 40% may suffer from depression.