Hospitalists ID Unprofessional Physician Behaviors

Ridiculing coworkers, clumsy and callous patient transfers, texting during meetings, and leaving work early were among a handful of rare, but unprofessional behaviors attributed by some hospitalists to themselves and more so to their peers, a survey published in the in the Journal of Hospital Medicine shows.   

The survey and study asked 77 Illinois hospitalists to identify what they considered unprofessional behavior in themselves and their colleagues. 

Funded by the Society of Hospital Medicine, the study found that the most common unprofessional behaviors that hospitalists reported participating in were:

• Having personal conversations in patient corridors (67%),
• Ordering a routine test as urgent to expedite care (62%),
• Signing out a patient over the phone when it could have been done in person (41%)
• Making fun of other physicians to colleagues (40%).

Not surprisingly, when hospitalists were asked if they observed those behaviors in colleagues, the figures were much higher, at 80%, 80.5%, 66%, and 67.5% respectively.  

Study coauthor Vineet M. Arora, MD, from the Department of Medicine at the University of Chicago, says there is growing concern about the discrepancy between what is taught about professionalism in formal medical education and what is seen on the ward. She says government regulatory agencies are also pressing medical schools to evaluate their learning environments and the impact on professionalism. 

"We had been doing some work about professionalism among students and residents. There is a lot of literature in those areas that the learning environment in academic medical centers may not be as positive at all times as it should be. We often heard from student residents that we should expand our work to include faculty to better understand role models in the learning environments," Arora told HealthLeaders Media.

"We were reassured that the numbers for alarming behaviors were low. We had surveyed the same behaviors in medical students and residents previously. This is completing the arc to understand what role faculty play."

Arora says the survey's findings were used to build an intervention program video for behaviorally challenged hospitalists.

"We are not stating what is unprofessional. We want to know what the hospitalists think is unprofessional," Arora says. "We used a range of behaviors from extremely egregious to not really an issue. Talking in the hallway is not the same as disparaging the patient or backdating a note. We wanted in the survey to provide heterogeneity of behaviors so people could decide what was grey and what was definitely black and white."

"The idea wasn't 'let's go find out what the bad things are in the workplace.' We wanted to develop some targeted educational interventions to improve the learning environment but before we did we wanted to know the behaviors to target," she says. 

Nearly 80% of the hospitalists who took part in the study completed their residency after 2000, 57% were male and 61% had worked with their current hospital group for one to four years. They graded more than 30 unprofessional behaviors on a five-point scale commonly used to measure attitudes or opinions.

Arora noted an interesting correlation between job characteristics of hospitalists and reports of unprofessional behavior.

"Hospital-based physicians have very different types of jobs based on whether they teach, or do administrative work, or clinical or night work and we found that your job type predicted some of the behaviors you participated in," she says.

"People often say the more clinical work you do the more burned out you will be. It turns out that actually in our studies the people that had less clinical time were more likely to engage in behaviors of making fun of people. We found an inverse relationship."

Arora says the findings suggest that clinicians put a premium on maintaining good personal relationships with colleagues.

"Contrary to popular belief those physicians who are doing more clinical time actually were less likely to report unprofessional behavior in certain domains," she says. "Whereas if you don't do a lot of clinical work and your primary job is research or administration, maybe you are more likely to fall into the environment of making fun of people in the workplace."