The pop culture portrayal of physician arrogance is pervasive, but best embodied in Alec Baldwin’s depiction of an arrogant surgeon in the 1993 movie Malice. After explaining in a medical malpractice deposition that patients’ families are actually praying to him –not God– the Baldwin character finally cuts to the chase.
“You ask me if I have a God complex? Let me tell you something: I am God.”
But how closely does art reflect reality in this instance?
The recent survey by Medscape of 1500 physicians entitled Physicians Behaving Badly gives us some indication.
Among other things, the survey found that the vast majority of doctors had witnessed one of their colleagues verbally, and even physically, abuse one of their co-workers or act with hostility toward their patients. This even included mocking descriptions of patients’ physical appearance, race, and disabilities. Forty-three percent had seen another doctor drunk at work and, only somewhat less frequently, had become aware that one of their brethren had tried to date a patient. One doctor had posted a picture of himself in an exam room dancing with a post-plastic surgery patient—who was naked.
In terms of demographics, the physicians behaving badly were more likely to be male (77% vs. 23% women) and aged 40 to 60. In what indicated a serious lack of self-awareness, the doctors’ perception of themselves was hard to reconcile: 85% denied behaving badly while only 15% admitted they ever had.
What’s going on out there?
The easy answer is that the current hospital ecosystem is endlessly frustrating, a well-documented phenomenon that has led to significant healthcare worker disillusionment before and after the pandemic. The bad behavior then reflects doctors “acting out” in response to the untenable world they/we occupy. In my work as a consultant to several hospitals across the country—in my field of organ transplantation, where teamwork is essential—the most common trait of underperforming programs, by far, is team dysfunction. Teams of doctors who don’t get along well—and are even hostile toward one another—don’t put the patient at the center of their care matrix. Instead, their dysfunction becomes the most notable part of the team’s and the patients’ experience. Members of teams like this are overworked, look to spread the blame to others when things go wrong, and have trouble acknowledging their own mistakes, let alone taking measures to fix them.
Would you want to be cared for by a team like that? Me neither.
But as the survey shows, many patients are.
Aside from the difficulties our healthcare workers are experiencing, leading many to consider seeking a new career, the second most common reason for doctors behaving badly was reported in the survey to be general arrogance. But are physicians as a group any more arrogant than other professions, say Wall Street traders, attorneys, or wealth managers?
Probably not, but we physicians have a ready excuse for our misbehavior: we are trying to save lives and, you know, that’s stressful.
But one thing that distinguishes us from other professions is the public’s high expectation of doctors—and the lofty expectations we have of ourselves. The survey indicated that 70% of doctors said that the bad behavior of one doctor taints the entire field. It is unclear if other professions hold themselves to the same standard. But it’s safe to say that despite our high expectations of ourselves, the bad behavior continues—and may be worsening.
The medical profession has failed to police itself. Nearly 70% of respondents to the Medscape survey said that incidents of bad behavior did not result in disciplinary action. In my years working at some of the nation’s finest hospitals, that was my experience as well—within those walls, there was a poorly kept secret that those in charge would display Greater Tolerance for Greater Talent, a phrase we often tossed around while shaking our heads. In other words, the most gifted among us—which could be read as those that generated the most revenue for the hospital—are given all sorts of leeway in terms of their peers, including instances of sexual harassment or the creation of a hostile work environment.
But this sort of conduct goes far beyond creating a toxic work environment. It has the potential to cause direct harm to patients. An example: when patients were put under anesthesia for an operation—and kept under for hours—until a surgeon was moved to emerge from his office to operate, no one said a word, despite it being well known that long durations under anesthesia lead to poorer patient outcomes. In this instance, behavior that was a patient safety issue, and well-known to nearly everyone in the hospital, was accepted, because the surgeon was internationally renowned and attracted hundreds of referrals each year.
What can be done to correct this kind of behavior and put patients first, instead of just paying lip service to that notion?
The reflex would be to recommend “civility training” as part of the medical school curriculum or during residency training (and perhaps, even beyond). In nearly every medical center, there are other training programs already in place that try to achieve the desired behavioral outcome among doctors concerning sexual harassment and diversity, equity, and inclusion. While the goals of these initiatives are laudable, a positive impact is not guaranteed by their mere presence.
Are there studies that validate these efforts as beneficial? I could find none. In fact, some research suggests that they have the opposite of the intended effect.
So, should we launch into another behavioral reorientation effort to train doctors to treat each other and their patients better?
My experience both as a practitioner and a consultant makes me believe that the only answer to physicians behaving badly reverts to hospitals. A good place to start would be consistent with what is tolerated. If a nurse, for example, shows certain behavioral tendencies, he or she is shown the door without much fanfare. The lack of disciplinary response to physician misbehavior—demonstrated in the survey results and witnessed regularly by me during the course of my career—needs to stop. Turning a blind eye to it encourages further dysfunctional behavior. And as with most flaws in health care, the patients are the ones that bear the cost.
In their mission statements, most hospitals claim that they strive to deliver “patient-centered” care. For these hospitals, policing their own would be one way to show it. Doing so would positively affect every single patient or potential patient—which means everyone.
Dr. David Weill is the former director of the Center for Advanced Lung Diseases and the Lung and Heart-Lung Transplant Program at Stanford University Medical Center. He has written for The Wall Street Journal, LA Times, Washington Post, STAT, and Newsweek, among many other outlets. He’s also the author of Exhale: Healing, Hope, and a Life in Transplant.