Yelling. Screaming. Swearing. Angry outbursts. Negative or demeaning comments about patients, physicians or other health professionals. These are all examples of disruptive behavior that can impede high-quality care and contribute to low morale in health care organizations. And they may also be a manifestation of physician burnout and a signal that systemic change to restore joy in practice is needed.
It is unclear how common disruptive behavior is, with estimates stating that between 1 percent and 5 percent of physicians have demonstrated such behavior. Yet what is clear, experts say, is that one critical step to dealing with the problem is to have clear guidelines for identifying and fairly addressing this behavior.
A new AMA continuing medical education module can help physicians and their medical staff organizations adopt such guidelines. Physicians and other health professionals can participate in this free online module to define appropriate, inappropriate and disruptive behavior. After completion, hospitals will receive a downloadable copy of the AMA Model Medical Staff Code of Conduct that can be integrated into their own medical staff bylaws.
“Over the course of my first 10 years of practice as an intensivist and as the medical director of an ICU [intensive care unit], I experienced firsthand how the stresses of caring for critically ill patients can affect the behaviors of even the best physicians,” said Hoyt Burdick, MD, a pulmonologist and chief medical officer at Cabell Huntington Hospital in Huntington, West Virginia. “Some of these behaviors have the potential to affect the dynamics of the bedside care team and may even adversely impact the safety of patients.”
“With proper introspection and honesty, we come to realize that there are moments in each of our professional careers in which our reaction to stress adversely influences our behaviors. I’m not sure anyone is immune from having a bad day,” added Dr. Burdick, a member of the AMA Organized Medical Staff Section Governing Council.
“What we learn from our own experiences and what is brought out so well in this new online AMA CME module is that as physicians, we are responsible for being aware of how we react to those bad days and how our behaviors and nonverbal communications affect everyone around us,” he said.
Leveraging a code of conduct
The AMA adopted an ethical opinion in 2017 that recognizes the “importance of respect among all health professionals as a means of ensuring good patient care is foundational to ethics.” The opinion also states that health professionals have a “responsibility to address situations in which individual physicians behave disruptively.”
While this is not a widespread issue, physicians who display disruptive behavior are often repeat offenders. And without an appropriate plan or set of guidelines available, it can create a barrier to dealing with the behavior.
“In my subsequent role as a chief medical officer, I’ve come to realize that if a medical staff doesn’t establish and clearly communicate a culture of expected behaviors or a written code of conduct, it becomes more difficult for medical staff leadership to hold an individual physician accountable for behaviors that don’t meet those expectations,” said Dr. Burdick.
“The medical staff should also resist the tendency to take complaints at face value without careful investigation,” he added. “The written code of conduct becomes a useful reference for evaluating and subsequently modifying behaviors that are inappropriate or disruptive. Through a series of realistic scenarios, the online AMA CME Module provides insightful contrasts between appropriately advocating for patients and behaviors that are counterproductive.”
Linking to burnout
“Inappropriate or disruptive behavior by a physician, while more commonly attributed to underlying disposition, frustration or fatigue, may also be symptomatic of more serious problems associated with professional burnout, including depression or substance use,” said Dr. Burdick.
He added that in a March 2017 sentinel event alert, the Joint Commission discussed the link between joy in practice and patient safety, which stated, “Having care team members who gain joy and meaning through their work has been found to have an important role in establishing and maintaining a safe culture.” And that “clinician burnout is associated with lower perceptions of patient safety culture and may directly or indirectly affect patient outcomes.”
“Patient experience and outcomes are better in an environment of dignity and respect,” said Dr. Burdick. “This environment does not preclude physicians from advocating strongly, but appropriately, for their patients. ... Balancing respect with advocacy may be one of the keys to both restoring joy in the practice medicine and reducing the risk of professional burnout.”
The CME module is available in the AMA Education Center. The AMA has designated this enduring activity for AMA PRA Category 1 Credit™.
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