How medicine must address the deeper causes of disruptive physician behavior

Shockingly crude and disruptive behavior on the part of physicians may be rare, but there is a movement afoot in medicine to stop perpetuating a culture that tolerates such acts. Giving physicians more ethics training and encouraging bystanders to report bad behavior only address part of the problem, however, according to a commentary in Medscape. 

Arthur L. Caplan, Ph.D., head of the Division of Medical Ethics at New York University Langone Medical Center, writes that the other prong of the solution is to offer physicians better support for the vast emotional difficulties that come with the job--and to stop expecting doctors to "macho it out." In other words, it's not just the harms inflicted by physicians that need to come out of the dark, but also the harms they are suffering.

In reference to "Our Family Secret," an anonymous essay published by the Annals of Internal Medicine that revealed horrifying stories of physician misconduct, Caplan explained that his initial reaction was that medicine needed to redouble its efforts to teach physicians what behavior was unacceptable.

But doctors likely already know that making sexual or disparaging remarks about patients under anesthesia is wrong, he continued, and the deeper issue at hand is extreme physician stress.

"What I think is going on is that we're not giving enough support to people who are often practicing under a lot of tension--facing almost posttraumatic stress disorder (PTSD)-type circumstances--and may be afraid to ask for help," he said.

Physician colleagues, therefore, have a responsibility to not just speak up about inappropriate behavior but to also look out for one another, Caplan said, and suggest to other doctors acting egregiously that they get help coping with tension or stress.

Part of the aim of the American Medical Association's new STEPS Forward program is to provide physicians with tools that help make their work lives a little easier and therefore stave off burnout.

Other research has revealed, meanwhile, that a variety of strategies, such as offering physicians paid protected time or facilitated discussions about job stress, can help ease symptoms of burnout--though the makeup of effective interventions varies among individuals, FiercePracticeManagement reported previously.

To learn more:
- see the commentary
- access the essay (subscription required)