As I travel about the decaying world of civilized conversation, I have come to realize that people have varying opinions of physicians. As the gatekeepers of medical care, perceptions of doctors, based on cause-and-effect, eventually determine a person’s level of personal investment in their own health.
Having had five doctors in my family, I have absolutely no fear, and admittedly few ill feelings, towards those on the delivery end of the medical profession. When my pediatrician was “Uncle Ed”, how could I? With that said, knowing the dedication of the physicians in my family has given me a tremendous sense of what I like to refer to as “quack radar”. There have been providers who in the past have only seen me once, and then briefly, as the internal blips in my head have indicated that there is something about the encounter that isn’t in my best interests long term.
Which brings me to a white paper that was released this week regarding disruptive physician behavior. The report is a joint effort between a physician learning and communication collaborative called QuantiaMD and the American College of Physician Executives. The report is the result of a survey of 840 physicians and physician executives.
The report shows that roughly 71% of physicians state that they have noticed at least one instance of disruptive behavior by a fellow physician per month. Among the aberrant behaviors most often encountered are degrading comments or insults, refusal to cooperate with other providers, refusal to follow established protocols and yelling. The use of profanity came in a strong fifth among a list of 13 disruptive behaviors.
It is revealing that the behavior most concerning to the parties surveyed was the refusal to cooperate with other providers. Step back a moment and think not only of our current health care model, but the Accountable Care Organization model currently on the table as the proposed future of patient care. Increased integration and collaboration is envisioned as being the key to the elimination of redundancy and, by extension, the reduction of healthcare costs, leading to institutional savings.
If the physician community is encountering barriers to care in the form of lack of cooperation from other health care providers, all models for integration, savings and, ultimately, better patient outcomes, grind to a halt. Consider that 90% of respondents to the survey believe that disruptive behavior either always or sometimes affects patient care. In the pre-ACO world, patients face the choice that I myself have been faced with in the past; stick around for care that would not be in my best interests, or find someone else to be the gatekeeper of my care. The ripple effects are something of a one-to-one measurement of one doctor’s loss to one doctor’s gain.
Now consider the proposed integrated model. With a healthcare facility as the hub of care, everybody’s reputation stands to take a hit for the actions of a few abrasive personalities. Unless the hub facility has firm policies of reporting such incidents, with appropriate progressive discipline up to and including discharge for the most egregious violations, potentially every provider of services presents a threat to the organization.
Having passed the halfway mark in my life, I’ve made a commitment not to surround myself with miserable people or those whose attitude I find aggressive or prickly. Personalities like this drain the air out of the room and eventually lead to a toxic environment. When such a personality is your medical professional, it could be a direct threat to a healthy existence. From the results of this report, enough physicians see this as an ongoing problem. The question now becomes how important such an issue is to health care organizations, and whether the potential risk to reputation will finally be enough to force them to act.