The "House" Effect: Physicians Behaving Badly

House M.D., is an award-winning TV drama that revolves around the show’s main character, Dr. Gregory House, who solves medical mysteries while offending patients and colleagues with his misanthropic behavior. Apparently, this fictional character may be closer to real life than some would believe.

A new survey of 840 physicians and physician leaders found that many have routinely seen their peers behaving badly.

The study, conducted by the American College of Physician Executives (ACPE) and QuantiaMD, a Waltham, Mass.-based mobile and online physician community, found that more than 70% of physicians polled said that disruptive behavior occurs at least once a month at their institutions, and more than 10% said they’ve witnessed such incidents happening daily. Nearly all of the physicians surveyed said they believed that disruptive behavior hurts patient care.

Incidents of bad behavior cited by the survey ranged from discrimination, to substance abuse, and even physical assault. Among the more common behaviors reported were inappropriate jokes, profanity, spreading malicious rumors, and throwing things.

The study found, however, that the behaviors physicians found most worrisome included refusal to cooperate with colleagues, refusal to follow established protocols, yelling, and degrading remarks or insults -- more than half of all respondents reported they had experienced each one.

Just over one-quarter of respondents admitted they themselves have been guilty of disruptive behavior in the past, citing a burdensome workload and behaviors learned in medical school.

The issue of doctors behaving badly gained national attention recently after New York Times contributor and nurse Theresa Brown wrote about her experiences with doctors bullying nurses. (She also wrote about nurses bullying other nurses.)

Along with the survey, the ACPE published a white paper citing specific examples of disruptive behavior, including:

• A doctor with a history of rudeness yelled at a nurse, resulting in "a significant medication error and harm to a child."
• A surgeon's degrading comments to nurses and other medical personnel led to "shoving and pushing...in the OR."
• A male doctor created a hostile work environment for a female physician supervisor through "condescending, bullying" and refusing to acknowledge her supervisory role.

The ACPE survey found that, as a result of these types of disruptive behaviors, 60% of respondents said that their practice or institution had experienced written complaints; half said they had patients switch doctors or leave practices as a result; and more than 20% of respondents directly attributed an adverse clinical event to a disruptive physician.

“Despite the best efforts of many, and the extremely high level of awareness by physicians that our communication has an impact on patient safety, our profession continues to experience disruptive behavior,” said Barry Silbaugh, MD, MS, FACPE, Chief Executive Officer, ACPE.

While more than two-thirds of the respondents said their organizations had policies to report and police disruptive incidents, almost one-quarter said they felt uncomfortable directly confronting disruptive physicians. Female physicians felt less comfortable than males in confronting disruptive behavior, and 77% of all respondents said they needed training on how to deal with it.

The study acknowledged that it’s impossible to determine if the survey is representative of a widespread problem. "It is possible that the respondent group was either more interested in or more likely to have experienced or witnessed disruptive physician behavior," the white paper acknowledged, though it noted that “while a relatively small number of individuals are at the center of this dysfunction, their behavior creates a ripple effect that touches all of us: physicians, nurses, patients, and families.”