In the good old days, women were women, men were men, and it was OK for a physician to be a total jerk in the hospital as long as he or she was very talented. More than one physician got away with appalling behavior because he was Cezanne with a scalpel or Stieglitz with a stethoscope. Well, as Hippocrates would have said, “You can kiss that crap goodbye.” The days of jerks practicing medicine are coming to a close, to which I and most who have ever worked with one say, “Don’t let the door hit you in the fat head on the way out.”
There are a lot of reasons the days of Dr. A. Bastard terrorizing nurses and other staff with his or her short temper and blistering tongue are over. Physician worship is no longer the norm in health care, and the idea that a physician should be forgiven juvenile behavior just because he or she heals the sick is itself terminally ill. Many women who had to put up with this treatment when they were young nurses because their hospitals would not back them up if they confronted the behavior now run hospitals and do not have to tolerate the bad boys and girls of the medical staff anymore. Allowing physicians to abuse staff can get a hospital in legal trouble, or cause excellent staff to leave.
Perhaps most important, we have also come to realize that abusive physicians can make hospitals less safe for patients. Studies of catastrophic errors in hospital care have frequently found that one or more staff members may have known a physician was doing something unsafe, or had ordered the wrong dose of a medication, and remained silent because they were afraid to anger the physician. A survey by the Institute of Safe Medication Practices found that “40 percent of clinicians have kept quiet or remained passive during patient care events rather than question a known intimidator,” according to a recent patient safety alert from the Joint Commission, which accredits many American hospitals.
I learned this by the time I was a lowly intern in training; if you were a jerk on call at night, nurses were less likely to page you and wake you up with a question or concern. Surprise! That kind of culture of intimidation and poor teamwork is less acceptable in hospital care now because patients may suffer if nurses and other staff are reluctant to speak up when they see something going wrong.
While physicians are the highest-profile pit bulls of patient care, they are not the only ones. I have worked with nurses who could have outchewed a Rottweiler, pharmacists with the personality of hemlock, and respiratory therapists who would have made me want to shut off my own life support. All were poor team players whom few others wanted to work with or to anger by suggesting nurse Chainsaw might be making a mistake in patient care.
This growing awareness that intimidation in health care can lead to unsafe patient care recently prompted the country’s leading hospital safety organization, the Joint Commission, to require hospitals it accredits to establish a code of conduct “that defines acceptable and inappropriate behaviors,” and hospital “leaders [to] create and implement a process for managing disruptive and inappropriate behaviors.” It is about time.
Many hospitals have been way out in front of the commission on this and have put abusive physicians and other staff on notice that there is a new behavioral sheriff in town. The work of changing that behavior has been difficult, often requiring hospitals to discipline or fire these physicians, or boot them off their medical staffs. In turn, some of those physicians have sued or taken their business elsewhere, often claiming no one ever told them they were doing anything wrong. Some have claimed they were not being abusive, they were just being demanding on behalf of good patient care.
As my daughters would say, “Whatever, doc.” The day those docs and others who behave like them are all gone will be another day that’s better than the so-called “good old days of medicine.”
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.