Trial lawyers know the drill: a physician acts out, does not follow the behavioral code, bullies the nurses, and has temper tantrums. The hospital administration turns a blind eye, coddles the physician, and compliments his or her skills. Patients and staff are harmed in the process, but that high revenue doctor is kept on staff. He or she brings in the patients and the dollars.
I think about a nurse who came up to me after I presented at the Academy of Medical-Surgical Nurses annual meeting in Boston in 2011. He told me a story of being threatened by an orthopedic surgeon, who was unhappy with his performance in the operating room. The nurse was new to the setting and told the surgeon that, but the surgeon expected him to read his mind and know exactly what he wanted, in advance. The surgeon was so irate at the end of the surgery that he grabbed the nurse’s scrubs, in his bloody glove, and threatened him.
When the nurse’s complaint to the hospital administration resulted in a reply of, “You know, he admits so many patients to our hospital”, the nurse struck back in another way. He convinced two of his relatives who were to have orthopedic surgery by this doctor to go to another doctor and hospital. The surgeon lost the income and the nurse’s hospital lost the admission and income. And the nurse was blamed and chastised by his hospital for striking back.
A recent HealthLeaders article, called “The End of Us Versus Them” in the April 2012 issue, points out that positive physician relationships have never been more important. The author sounds a hopeful note that it is becoming easier to cultivate these relationships because of legislative and contractual changes. These are aligning hospital and physician incentives and causing a re-examination of relationships. If you can wait that long, a new generation of physicians is more willing to collaborate with the hospital system.
I say it’s about time. It is, in fact, way past time. Physicians are ultimately concerned about delivering excellent patient care, the article states. I can attest to that fact from witnessing an irate physician who did not see his or her orders carried out. But the reality is that the healthcare environment is highly dependent on cooperative team behavior. Divisive, “he versus they” behavior exacerbates the stress of health care. The solution lies in integrating physicians into hospital management positions, teaching them how to communicate with the team, and holding them accountable for bad boy behavior. I don’t think we will ever eradicate the bad boy behavior, but we can, through the litigation system, hold these offenders responsible for the disruptive behavior that results in a medical error and patient injury.
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