Running with scissors?

Today I got into a conversation with an anesthesia colleague about bullying behaviors displayed by surgeons and the impact of that behavior on the perioperative work environment.  This is an area I’ve been doing research on for a couple of years now, trying to push our definition of disruptive surgeon behavior past “I know it when I see it,” and (more importantly) trying to understand why this behavior happens and how we move past it.  I’ll confess that part of my motivation is purely selfish- I’m a believer in having a pleasant workplace where everyone can work together for the same goal.  The more altruistic motivation lies in the impact that disruptive physician behavior has on patient care.  Any modifiable factor that can negatively impact the care of patients should be removed from the system, and this is clearly one.

In 2008, The Joint Commission released Sentinel Event Alert Issue 40, which included disruptive clinician behaviors as a key factor impacting patient safety.  A multicenter survey conducted that same year showed disruptive behavior to be nearly epidemic- and that my own people (general surgeons) were apparently the most disruptive.  Fortunately, this study also included a list of recommendations to help institutions address cultures that have historically permitted disruptive behavior.

Have the intervening years brought significant improvement, now that this issue has been named?  According to an Institute for Safe Medication Practices report released last year, not really.  In fact, this report notes that physical abuse, while rare, increased in frequency over the last decade.  Obviously, we can’t determine if it’s simply that people are finally willing to report it, or if there has been a genuine (and disturbing) upswing.  Respondents to the ISMP survey also indicated very clearly that prior experiences in which they had been intimidated of disrespected impacted future interactions, and would make them more hesitant to approach a disruptive provider about a safety concern with a patient.  In my mind the most unfortunate finding from the ISMP report was the frustrating expressed by responding providers in terms of redress of disruptive clinicians; 25% of respondents felt that their organization had an effective process for dealing with disruptive clinicians.

The ripple effect of disruptive behaviors on our trainees and students cannot be underestimated.  In my own research, medical students consistently identified that they were deterred from pursuing careers in surgery primarily due to negative role models.  While I know that these talented students will do well in their chosen fields, this represents an unnecessary loss from the potential talent pool for surgery, academic or otherwise.  For learners to self-select out simply because they are nice people who don’t want to turn into “THAT” surgeon  is embarrassing.

Do I have a solution?  Not yet.  The issue is complicated, with variables that have lots of shades of grey.  Am I committed to finding a solution?  Absolutely.  What we’re doing now isn’t working.  It’s impacting the safety of our patients and the future of surgery- both things I am passionate about.

2 thoughts on “Running with scissors?

  1. When I shared with my classmates in medical school I had decided surgery was for me- I was met with an unanimous “But you’re too nice for surgery!”
    While I was influenced by great role models in medical school, I certainly went in eyes-wide-open that I was not the typical personality.
    The bigger issue you raise is the effect this has on team morale (yes trainees, but also nurses, ancillary staff, consultants, even administration) and how it may add to burnout — both which may ultimately affect the patient.

    1. Minerva, excellent point about the impact on ancillary staff. Staff turnover is higher when they are dissatisfied with their working conditions, and that includes working with people that aren’t pleasant to be around. Hiring and training of new staff is not only a challenge to care, but it’s expensive for the healthcare system!