The days when physicians could act out are over!

It’s tragic to see a promising doctor be overcome by their demons.

One of my best friends in medical school struggled with an untreated mental health disorder that led him down a dark path of lashing out at coworkers and coming to work intoxicated.

He was using alcohol to cope with all of his underlying triggers, but when his misuse spiraled out of control, he nearly destroyed his career. We ended up going to different residency programs.

With our demanding schedules, I barely had time to talk with him. One day, he called to tell me he was taking mandated time off of residency to enter a substance abuse treatment program. The program administration was firm with his disciplinary action, but allowed him to resume his residency after proving he was in control of his mental health and substance use.

Prevalence of toxic behavior

Physicians are held to a higher standard, as we hold people's lives in our hands. We can be harshly judged for our workplace behavior. It’s a double-edged sword, but there's a fine line between disruptive behaviors and not winning the congeniality award.

A Medscape survey published in 2021 asked 2,000 physicians about inappropriate and disruptive behavior in and out of the workplace.^[] Here is what it found:

• Thirty-five percent said they had witnessed colleagues behaving inappropriately in the workplace, 26% outside the workplace, and 26% on social media.

• The five most common poor behaviors reported in and out of the workplace included bullying/harassing coworkers, making fun of patients behind their backs, using racist language, physical aggression towards staff or patients, and being intoxicated.

• Forty-one percent believed society's standards for physicians outside the workplace were too high, and 61% felt they should be able to act however they want in their personal lives.

• Forty-four percent said that physicians most commonly misbehaved in the workplace, with the most-seen inappropriate acts including filming videos, dancing while operating, showing images of patients’ faces without consent, cursing and yelling at staff and patients, groping nurses, and pushing pyramid schemes on coworkers.

When the line is crossed

The AMA has adopted an ethical opinion recognizing that “respect among all health professionals as a means of ensuring good patient care is foundational to ethics.”^[] The opinion also stated that healthcare professionals have a “responsibility to address situations in which individual physicians behave disruptively.”

Like anyone, we’re not immune to bad days. But having one doesn’t justify behavior in which we could harm patients, coworkers, or ourselves.

Constructive feedback, dissatisfaction with hospital policy, concern about patient safety, taking a respectful stance on a controversial medical issue, and speaking about quality concerns are all examples of appropriate physician behavior.

Disagreements may occur, feelings can be hurt, and emotions can get the best of us during these difficult discussions, but crossing the line into inappropriate or destructive behavior should always be avoided.

Examples of inappropriate and disruptive behaviors include:^[]

• Physically threatening co-workers, patients, or family members

• Persistent inappropriate behavior that rises to the level of harassment

• Throwing things

• Deliberately not returning pages, calls, and messages

• Calling people names or making belittling, condescending, or sarcastic statements

• Using profanity

• Not responding to staff requests or patient care needs

Consequences of this behavior

For coworkers, disruptive physician behavior can lower morale and productivity, and disrupt the workplace due to increased stress and employee turnover. Camaraderie is impaired, leading to a less efficient and functional team.

Economic consequences can include slowed patient turnover due to decreased efficiency, elevated costs for hospitals due to an increase in errors and adverse events, and financial hardship resulting from liability claims. For patients, in addition to their safety being compromised, their satisfaction with care can deteriorate.

When to report a disruptive physician

The first step is to talk directly with the offending physician, or take your concerns to the hospital administration or clinic director. If the offending individual is part of leadership, go to the hospital ethics committee or report to the state medical board.

There is no "wrong" way to report inappropriate or disruptive behavior, but remember that filing a false report can result in disciplinary action and destroy a physician's reputation. Therefore, it’s vital to be 100% confident that the behavior falls under disruptive or inappropriate rather than the physician having a bad day or not being a people-pleaser.

Addressing behavior

Discussing disruptive behavior in an informal, relaxed setting with an executive or physician mentor can help you determine a desirable outcome. A private conversation with a colleague may be most appropriate if a physician has a one-time, uncharacteristic outburst.

Unfortunately, the troubled physician may have long-established behavior patterns and lack insight into their conduct. In these cases, prolonged, intensive counseling may be required to change these patterns.

Doctors in this position frequently must be mandated to enter counseling programs, as they may be reluctant to voluntarily seek assistance.