The EMRs (electronic medical records) bugged him worst of all. Throw in the stress of dealing with patients, procedures, even family life, and he was cranky. Steven Feeney, MD, admits he was not a terrific guy to work with.
Feeney, 55, an internist at Johnson Memorial Hospital system in tiny Dawson, MN, also didn't realize he was becoming something of an archetype: the disruptive physician.
Through much of the past year, "things were getting frustrating for both me and the other physicians; different problems were affecting us," Feeney recalls. "We had our own frustrations with the level of work, the relations with administration, and also very big frustrations with the new EMR system. The stresses and strains were telling in our lives." says Feeney.
Feeney mentioned various 'frustrations" three times in two sentences. Like many physicians feeling angst, he had been for a while, and had been acting out those frustrations on others. Feeney grumbled or spoke out more than he thinks he should have, but other physicians have behaved worse – yelling, name calling, tossing things and hurting colleagues.
Those incidents are spelled out in a white paper on "Disruptive Physician Behavior," from the American College of Physician Executives and QuantiaMD. The report tallied 70% of 840 physician leaders who said disruptive behavior occurs at least once a month at their organizations, and more than 10% say such incidents occur daily. At least 77% physician executives say they are concerned about disruptive behavior.
Most alarming: 99% say that disruptive behavior affects patient care.
Physician disruption at his hospital mostly manifested itself in doctor relationships with nurses, Feeney says. It was typically triggered by "a culmination of a series of problems that occurred before" someone lost their temper.
Feeney says he's seen outbursts at the hospital where physicians, in his words, were "acting like four-year-olds," he among them. "There have been times where I've had to deal with these individuals (causing disruptive problems), and sometimes I've had to deal with myself," Feeney says. "That behavior is not tolerated and will not be tolerated in the future. We can't bury our heads in the sand."
Experts say physician disruption issues start in medical school. "Combating this phenomenon is an uphill battle," Barry Silbaugh, MD, MS, FACPE, CEO of American College of Physician Executives wrote in a foreword to the organization's report. "For many of us, this is behavior we learned from abusive instructors in medical school. The constant stress, long hours, and bureaucratic quagmires inherent in health care serve to exacerbate the situation. It's not getting any easier in this era of reform, where the rules seem to shift from day to day and the financial rewards may be shrinking."
Still, too many physicians still don't recognize that "heal thyself" applies to them.
Alan Rosenstein, MD, medical director of Physician Wellness Services, Minneapolis, MN, which advises physicians dealing with stress and burnout issues, says there haven't been enough advances in dealing with physician misbehavior issues.
"If you look at the results in the current ACP (report), it's exactly the same kind of results we were seeing in other studies in 2000, 2005, 2008 and 2010," Rosenstein says.
"We've got to promote a safe patient environment," he says. "Until we address the human behavior issues, we're never going to get to the point where we need to be. This issue is still difficult for organizations to address, particularly the physician behavioral issue. Many organizations are taking this to heart and a lot of people are trying to prevent bad things from happening."
Silbaugh says disruptive physician behavior is an issue that won't go away. "Despite the best efforts of many, our profession is still plagued by doctors acting in a way that is disrespectful, unprofessional, and toxic in the workplace," he says.
Feeney and officials at Johnson Memorial Hospital want to banish disruptive physician behavior, although they admit it's a challenge. They have been discussing stress and burnout with Physician Wellness Services. Feeney concedes he was apprehensive when the sessions began several months ago.
"We're all trained to help others and when we have to help ourselves, we think we're not supposed to have these problems," Feeney says. "That ego problem, a lot of time, is fed by inner doubt. How everybody wants everything perfect all the time."
The hospital administration and physicians are working diligently to change behaviors and "I'm seeing responsiveness on the part of physicians and administration that wasn't there before," he adds.
"You need to let go of the things that bothered you in the past, they are done, they are over with and you move on," Feeney says. "I asked myself, how can I look at things different, how can I act differently?" he asks.
Since confronting his own disruptive demons, Feeney says he's seeing positive changes, in his own behavior, a step forward.
About those EMRs? "Doing electronic prescriptions, I thought at first it was a hassle and too much work," he says. Now, he adds with a slight laugh, "I love it. I change the prescriptions with it. It works well."
See Also:
Kathleen Bartholomew: Standing Up to Physician Bad Behavior
AUDIO: Kathleen Bartholomew on bad behavior and bullying, Part 1
AUDIO: Kathleen Bartholomew on bad behavior and bullying, Part 2
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
