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workarounds, so the behavior continues.
• Not just yelling. Disruption can occur in many forms. Some doctors are
nasty to nurses or can't seem to get along with their peers. Some may actually
have physical encounters. Some refuse to follow instructions or safety proce-
dures. Some repeatedly make errors, and no one can figure out why. And occa-
sionally, you have a doctor who gets into a romantic relationship, or tries to,
with one of the nurses — what I call the Bill O'Reilly Syndrome.
• How it starts. In studies we've done of more than 300 disruptive doctors
over a number of years, we found that about two-thirds came from a back-
ground of either emotional abuse or neglect. Also, about one-fourth had addic-
tion issues — alcoholism, drug abuse or both.
• The med school factor. The way we physicians are socialized is also a fac-
tor. Starting in our teens, for 10, 12 or 14 years we're out of normal circulation in
terms of socialization. We spend those years studying like mad in college and in
med school, and when we get out, we're in our 30s. It explains why so many
have difficulty with the interpersonal aspects of medicine.
• First steps. The key is getting disruptive doctors to realize their behavior
isn't acceptable. Often, people don't feel they have the right to call out a doctor.
But the word unacceptable is powerful without being emotionally charged. That
doesn't mean it's OK to duke it out with the doctor, but it's OK to say, Excuse
me, I don't expect to be treated that way, or I felt disrespected when you said
that.
• High success rate. Some may be beyond hope, but good outcomes are
possible in a much larger percentage of cases than most people expect. The
effort to rehabilitate physicians is a good idea for several reasons: It's expen-
sive to replace them; many, even most, are solid practitioners — and some
are exceptional; and giving physicians a chance to change is consistent with
our mission in health care to promote health and wellness.
OSM
