It seems that everyone’s nerves are on edge right now, and people are often behaving in surprising ways. Physicians are no exception.
“The days of surgeons throwing retractors across the OR and screaming at nurses and medical students are hopefully gone now,” said Barron Lerner, MD, PhD, professor of medicine at New York University Langone Health and author of The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics. “We’re not going to tolerate that as an institution.”
But, Lerner said, bad behavior still happens. And according to a recent Medscape survey, it seems to be on the rise.
For the 2022 Physicians Behaving Badly Report, more than 1500 physicians shared how often they see fellow doctors misbehaving in person or on social media, and shared some of the worse behavior they’ve seen.
Though misconduct is still relatively uncommon among doctors, and most physicians say they’re proud of the high standards and attitudes of their colleagues, respondents to the survey did say that they’re seeing more frequent incidents of other doctors acting disrespectfully toward patients and co-workers, taking too casual an approach to patient privacy, and even acting angrily or aggressively at work. While the uptick is not substantial, it’s nonetheless worrying.
“I have increased concern for my colleagues,” said Drew Ramsey, MD, an assistant clinical professor of psychiatry at Columbia University. “People forget that COVID has made the physician workplace incredibly stressful. Physicians are struggling with their mental health.”
Bullying and Harassment Top Bad Behavior
When it comes to what kind of bad behavior was reported, bullying or harassing clinicians and staff was the runaway winner, with 86% of respondents saying they’d seen this type of behavior at work at some time. Making fun of or disparaging patients behind their backs was a close second, at 82%.
Ramsey thinks that these figures may reflect a deeper understanding of and sensitivity to harassment and bullying. “Five years ago, we weren’t talking about microaggression,” he said. This heightened awareness might explain the fact that doctors reported witnessing physicians mistreating other medical personnel and/or bullying or harassing patients somewhat more often than in last year’s report.
Docs were caught using racist language by 55% of respondents, and 44% reported seeing colleagues becoming physically aggressive with patients, clinicians, or staff. Other disturbing behaviors respondents witnessed included bullying or harassing patients (45%); inebriation at work (43%); lying about credentials (34%); trying to date a patient (30%); and committing a crime, such as embezzling or stealing (27%).
Women were seen misbehaving about one third as often as their male counterparts. This could be because women are more likely to seek help, rather than the bottle, when the stress piles up. “Some misbehavior stems from alcohol abuse, and a higher percentage of men have an alcoholism problem,” Ramsey pointed out. “Also, male physicians have historically been reluctant to seek mental health assistance.”
Doctors are behaving badly slightly more often, and their colleagues are slightly more willing to speak up about that behavior. Last year, 35% of physicians said they did nothing upon witnessing inappropriate behavior. In this year’s survey, that number fell to 29%.
Respondents largely agree (49%) that doctors should be verbally warned when they’ve behaved badly at work, yet only 39% reported speaking to a colleague who acted inappropriately, and only 27% reported the bad behavior to an authority.
Lerner points out that it is very difficult for doctors to speak up, even though they know they should. There are several reasons for their reticence, he noted.
“For one thing, we all have bad days, and the reporting physician may worry that he or she could do something similar in the future,” he said. “Also, there is the liability question. A doctor might think, ‘What if I’m wrong? What if I think someone has a drinking problem and they don’t, or I can’t prove it?’ If you’re the doctor who reported the misbehavior, you’re potentially opening a can of worms. So there’s all sorts of reasons people convince themselves they don’t have to report it.” But, he adds, “If you see it and don’t report it, you’re in the wrong.”
Off the Job
Work isn’t the only place where doctors observe their colleagues misbehaving. Sixty-six percent of respondents had seen disparaging behavior, and 42% had heard racist language, away from the hospital or clinic, according to the survey.
Bullying and harassment weren’t limited to work, either, with 45% reporting seeing a colleague engage in this behavior off campus, and 52% reporting witnessing a colleague inebriated in public. That’s actually down from last year when 58% of respondents said they witnessed inebriated doctors in public.
The public sphere has broadened in recent years to include social media, and there, too, doctors sometimes behave badly. However, 47% of doctors surveyed said they saw more inappropriate behavior in person than on social media.
When doctors do act out online, they make the same mistakes other professionals make. One respondent reported seeing a fellow physician “copying and posting an interoffice memo from work and badmouthing the company and the person who wrote the memo.” Another said, “Someone got fired and stalked the supervisor and posted aggressive things.”
Not all social media transgressions were work-related. One respondent reported that “a physician posted pictures of herself at a bar with multiple ER staff members, without masks during COVID restriction,” and another reported a colleague posting “unbelievable, anti-scientific information expressed as valid, factual material.”
Though posting nonfactual, unscientific, and potentially unsafe information is clearly an ethics violation, says Lerner, the boundaries around posting personal peccadillos are less clear. This is a part of “digital professionalism,” Lerner explains, adding that there is a broad range of opinions on this. “I think it’s important to discuss these things,” he says. “Interestingly, while the rules for behavior at the hospital have become more strict, the culture has become less strict.”
As one respondent put it, “What exactly is bad behavior? If you’re saying physicians should be allowed to sexually assault people and use drugs, then no. Can they wear a tiny bathing suit on vacation and drink cocktails with friends? Yeah.”
Avery Hurt is a Birmingham, Alabama-based freelance science writer who writes often about the science and practice of medicine.
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