By Irene Greenstein
Risk Management in Healthcare
Loyola School of Law
Master in Jurisprudence in Health Law
Dr. Blauhard's story…
The Chief of Vascular surgery, Dr. Blauhard, strode confidently down the central corridor of the operating theaters. Passing the open heart surgery rooms and the new hybrid theater he knew that his patient would be going to sleep in room 12, his room. The patient was lucky to have him as her surgeon. He had been vice-chairman of vascular surgery at a major university and had published extensively in his chosen field. He was viewed as a star. But he was not respected or revered or even liked by the staff at his new hospital. In fact, his behavior at the new hospital had been outrageous. He yelled. He criticized. He threw instruments. He humiliated nurses and technicians and even environmental services workers. He was insufferable to work with and for. So as he pushed through the doors into operating room 12 a sudden quiet fell and bodies tensed. The patient, scheduled for a popliteal aneurysm repair was fast asleep and intubated, sleeping deeply inhaling the agents that allowed the surgeons to invade and repair. The aneurysm pulsed quietly in the right leg, awaiting repair. The right leg was clearly marked across the front of the knee. But prior to prepping, the patient was rolled from the supine position into the prone position, effectively shifting the right leg to the left side of the operating table. As such, and with no one saying anything, the left leg was prepped and draped. The wrong leg was prepped and draped. But no one said anything. A surgical timeout was held but no one spoke up. They were all quite afraid to say anything. The surgeon asked for his scalpel and carefully incised the wrong leg… This is a true story from a hospital in located in NY City. This event happened 6 months ago despite this hospital being of 100 US Best Hospitals and on the forefront of quality initiatives, consistently implementing all required and voluntary surgical initiatives, including but not limited to universal protocol, time out, sign out, and hospital wide “speak up” campaign. Unfortunately, similar stories happen more often than we think and know about in both large urban teaching hospitals and small rural community hospitals across the country. While twenty-thirty years ago intimidating, argumentative or flirtatious behavior on behalf of a doctor was often not scrutinized, in today’s environment such behavior could end a physician’s career. With that being said, there are still doctors that raise their voice, point fingers, scream and yell. Doctors that throw surgical instruments and other objects, humiliate nurses and other healthcare professionals and even patients and family memebers. According to Weber, nearly “80% of 1635 of physician executives encountered problems with physician’s behavior at least three to five times a year and 35% encountered this same problem at least monthly.” 1 According to 4530 surveys of nurses, doctors and other staff from over 100 US healthcare facilities, 75 percent of the respondents witnessed disruptive behavior by doctors and 65 percent witnessed it at least five to six times per year2. Moreover, a study conducted recently by the American College of Physician executives identified that 99 percent of 840 responding physicians stated that they believe that destructive physician behavior ultimately affects patient care2.
According to the American Medical Association (AMA), disruptive behavior is defined as “any abusive conduct, including sexual or other forms of harassment, or other forms of verbal or nonverbal conduct that harms or intimidates others to the extent that quality of care or patient safety could be compromised.” 3 AMA continues to describe disruptive physician behavior as behaviors that include, but is not limited to: • Physically threatening language...