Nurses laud Ontario medical group's effort to curb physician disruptive behavior

September 15, 2004 -- Harold's Levy's article in today's Toronto Star reports that the College of Physicians and Surgeons of Ontario is trying to reduce disruptive physician behavior, which according to an article in the College's magazine poses staff morale problems and can threaten patient safety. Good quotes from leading figures in two Ontario nursing associations make clear that efforts to deal with the problem are important for nurses and their patients.

The piece notes that a new College program will try to address the problem of physicians who repeatedly "are rude, throw tantrums, or bully patients and co-workers" by helping physicians "deal with behavioural problems, such as outbursts of anger, while protecting patients and co-workers." There seemed to be some diagreement as to how common this conduct was. The director of policy of the Ontario Medical Association maintained that it was "extremely uncommon," while the managing editor of the College's magazine said that physicians who behave badly "are not in short supply." There did not seem to be any dispute about the common objects of the bad conduct, namely nurses, medical students, patients and their families, nor about the range of problem behavior, which reportedly included yelling, bullying, threats, non-responsiveness, and throwing objects. The medical association official stated that such problems are often caused by stress in the physicians' personal and professional lives. The College's magazine reportedly suggests that such conduct often goes unreported due to physicians' reluctance to break ranks, as well as nurses' fears of retribution and that they will not be taken seriously.

The article includes good quotes from two local nursing leaders. According to the piece, Ontario Nurses Association president Linda Haslam-Stroud said the program was long overdue, calling such conduct "a serious problem" and noting that she herself has seen physicians erupt in "unpredictable outbursts and throw whatever might be in their hands, including stethescopes and pens." Sylvia Rodgers, a board member of the Registered Nurses Association of Ontario, reportedly noted that her members' most common complaint was a "lack of respect" from physicians manifested in conduct such as rudeness, breaking off communication, and simply not listening. Rodgers made the excellent point that such poor communication threatened patient safety because it meant that "important information does not get shared."

See the article "Heal behaviour, MDs urged: Regulatory body targets rudeness, bullying, tantrums. Program aimed at physicians with chronic problems" by Harold's Levy in the September 15, 2004 edition of the Toronto Star.

Further reading on disruptive physician behavior:

Rosenstein, A.H. (2002). Original research: nurse-physician relationships: impact on nurse satisfaction and retention. American Journal of Nursing, 102 (6), 26-34.

Diana J. Mason RN, PhD, FAAN (2002). MD-RN: A Tired Old Dance. One mired in gender inequity and historic precedent. American Journal of Nursing, 102 (6), 7.

Mary K. Wakefield PhD, RN & Eileen T. O’Grady PhD, NP (2000). Putting Patients First: Improving Patient Safety through Collaborative Education (pdf)

Minneapolis Star Tribune: "Nurses brainstorm cures for job issues"

Aiken, LH, Smith, HL, & Lake, ET. (1994). Lower Medicare mortality among a set of
hospitals known for good nursing care. Medical Care, 32 (8). pp. 771-781.

Knauss, WA, Draper, EA, Wagner, DP, & Zimmerman, JE. (1986). An evaluation of
outcome from intensive care in major medical centers. Annals of Internal Medicine. Vol. 104. pp. 410-418.

J R Lave, W A Knaus, "The economics of intensive care units," in Medicolegal Aspects of Critical Care, K Benesch et al, eds (Rockville, Md: Aspen Publishers, 1986) 87-107.

Stein, LI, (1967). The Doctor-Nurse Game. Archives of General Psychiatry.Vol 16.
pp. 699-703.