The No Asshole Rule for Doctors: Hospitals Will Risk Losing Accreditation

I've written here and in The No Asshole Rule about how physicians are among the worst bullies, and also, about how when people around them (especially nurses) fear that they will be bullied for pointing-out mistakes by doctors, that the lack of psychological safety leads to more mistakes (and also drives good people out of nursing and other medical professions).  I have seen this kind of bullying first hand (see this post about Dr. Gooser) as well. And see this post too about an asshole infested hospital. It appears that with this recent court ruling against a bullying doctor and, more recently, with is new set of guidelines for hospitals for the Joint Commission, which accredits most U.S. hospitals, that the pressure against asshole doctors is mounting. I quote from this AP story:

'CHICAGO - Bullying doctors can make nurses afraid to question their performance, resulting in medical errors, according to a hospital group that announced new requirements for cracking down on intimidating behavior.

Outbursts and condescending language threaten patient safety and increase the cost of care, according to a safety alert issued Wednesday by the Joint Commission, an independent organization that accredits most of the nation's hospitals.

Hospitals will be required by next year to have codes of conduct and processes for dealing with inappropriate behavior by staff, said the group's president, Dr. Mark Chassin. Hospitals without such systems risk losing their accreditation, he said.

Powerful doctors mean money for hospitals because they choose where to admit their patients, but they "should not be left off the hook," said Dr. Peter Angood, vice president of the group, which is based in suburban Chicago.

Grena Porto, a nurse involved in the group's efforts, said nurses need to be "appropriately assertive" and feel safe enough to ask a doctor, "Are you sure we're supposed to operate on the right leg, rather than the left?"

Nurses, pharmacists and hospital administrators also can be culprits, but it's the doctors who bully nurses that are the most significant for patient safety, said Dr. Alan Rosenstein, a researcher on the topic. He applauded the group's action.'

Comments

[Blake Duckworth]

We'll I'm pretty sure this won't be approved. But here goes anyway,You wanna talk about bullying. Doctors are the biggest bullies on the planets, I have set here with a chronic disease for almost 2 years, chronic prostatitis, and can't get any treatment for it.The first urologist laughed and giggled and thought it was funny I was in pain, he put me on prednisone which spread the infection and made it worse. I asked one urologist if I could try the antibiotic cephradine, so he comes back and hands me the doctor script for a drug called suprax, he then lies and tells me surpax is name brand for cephradine.I found out different when I got home Turns out the drug was $900 for 4 weeks, and by the way before he left to go get his prescription pad he asked me "now you do not have any insurance correct ", I replied no and he giggled and said be right back. wow is all I have to say, I have zero respect for doctors at this point. The pharmacist tells me call over there and have them call you in a cheaper cephalosporin drug. I call back and they call in a different drug turns out it was $900 as well vantin. The pharmacist just shook his head and couldn't believe they did that, I could tell he was angry with them as well. It takes me 2 weeks to get back in touch with the nurse, as she is always out, or to lunch, or on break or something. After 2 weeks of calling I finally talk to her and she tells me the doctor is no longer interested in treating me and that I am allowed no drugs but the $900 ones. Then she hangs up the phone on me.

And no these drugs were not affective agents for prostatitis either, vantin and suprax are not even used for prostatitis. A quick google search will confirm that.

In fact if you wanna see how great doctors are go look up the disease Interstitial Cystitis, it is a known fact that for the average patient with Interstitial Cystitis
many misdiagnoses will follow and it can take up to an average of 4 years before the patient is diagnosed with the correct disease Interstitial Cystitis. many individuals with Interstitial Cystitis are laughed at by urologists and are told it is all in their heads.

Lets not forget the merry go round, when a doctor finds a sick and dying man. Instead of treating him he will send him on a merry go round of tests. Pumping as much money as he can out of the patient. Including do some of the same tests over and over and over when they show the same result again and again.

I even read a story about a woman who set around for 30 days with a bladder infection before receiving any antibiotics. She was shipped around between her family doctor and another doctor and they milked her for the money as she cried in pains for 30 days with a simple bladder infection. This was not a chronic infection either, this was the first time this woman ever had a bladder infection. She had nothing wrong with her , they were doing this to drain her money

[k hsu]

I think this blog has become a narrow minded assault at doctors. I am nephrologist and from time to time have to deal with rude doctors, physician and nurses. I would have to also say that the MBAs and MHAs that fill the upper echelons of our medical center have no clue about running a hospital. When the new CEO took over, bottom line went from 2 million to 12 million/yr. I always see this as a red flag especially given the fact that revenue has not jumped by the same degree. Mindless cost cutting have led to throves of physicians and mid levels leaving the institution. We now officialy have no proper ICU coverage yet advertises that we are the only hospital in town with in house intensivists. Talk about compromising safety.

Dr Hsu

[Jack Silver]

I am a medical practice management consultant and do get calls by employers (mostly physicians) to resolve issues their practices face. The most common issue I encounter is the employer is an asshole. Also, almost all of these employers are not aware that they are the source of their organization’s problems, for the most part.
For instance, I worked with a solo practitioner (physician) in Tomball, Texas whose office consisted of 4 employees. Within 12 months, this physician had hired and fired about 24 individuals. When I asked the physician what he thought the problem was regarding high staff turnover. He said "there are no competent employees in the area". For those who are not familiar with Tomball, it is about 15 miles from Houston. I stopped by the hospital the physician practiced medicine and met with the medical affairs officer. As soon as I dropped the physicians name the medical affairs lady gave me a sad look and said the doctor is rated as the worst mannered physician in the hospital. This comment confirmed my suspicion that this physician is an asshole. I tried to communicate to the physician that he needed to improve his behavior toward others, but it didn’t work. Sometimes, it is hard to teach an old dog new tricks.

[Diane19571]

I work as a Medical Assistant in a very busy Family Practice clinic. Most Doctors are nice, but some of them are so Narcissistic that they should go into their own practice. I have to take care of several doctors in a session, but a couple think I'm only there for them. They keep piling so much work on us and expect results in half the time. The Nurses also abuse us. The Nurses are all pushing 60 and burned out themselves, so the treat us nasty. There are way too many bosses and bossy peers. If you stand up for yourself after the abuse, you're labeled a "complainer" and "troublemaker". Because we're at the bottom, if we spoke to people the way the managers do, we get written up. More and more people are going to HR at the hospital because management ignores the abuse.

[Christine Goepfert]

In your blogs about assholes in the medical field you primarily mention physicians bullying nursing staff. In the hospital I am currently working (and is no exception to the rule!) it is actually the case that some of the nursing staff are bullying doctors and other people in the medical field. And nobody puts paid to this behaviour. Especially (but not only) residents and junior doctors are bemeaned and belittled in a most pestilent way without seniors being able (or willing) to protect them. It seems to be some kind of initiation ceremony. Survival of the fittest. Those who survive are glad to not be bothered again and prone to this contagious poison.

So I do think it is more a function of how far people are allowed to go in an asshole dominated workplace and to which extend their mean little power is allowed to be let out, not so much of the position itself. Envy and primary personality establish the basis. It is about setting boundaries which are as important in child education, psychiatric therapy, everyday life and working place.

[Kevin Rutkowski]

It looks like the research on asshole bosses has made it to the prestigious "The Onion" newspaper:
http://www.theonion.com/content/news_briefs/study_not_being_an_asshole

[PR]

Here's the flip side of this dilemma from the perspective of the physicians who feel victimized by the new Joint Commission standard. It's a very long article on the Semmelweis Institute's website, with references.
http://www.semmelweis.org/article_grosch.htm

[RUBBA]

My favorite is a physician with an MBA. It gives us hospital finance people a chance to be bullied as well, although, I rather enjoy it more than the nurse.

[Lavinia Weissman]

Doctors have in the past been trained to be prescriptive and thus if you are prescribing you are in a position of being right.

However it is no longer about training. The Wall Street Journal has been reporting on the doctor shortage and what that implies. It implies that the new generation of physicians
are committed to sustainability and what that implies for health and wellness, which means they have chosen to live that way and the current system is so mechanical it is now challenged to hire.

More and more people who are trained and degreed are chosing to work outside the insurance and government driven systems.

So while the Asshole Rule can be applied here, the entire system is falling apart in which we live and my research is showing the new behavior is key to the practice of new medicine which begins with listening and letting the patient and other people contribute, make decisions and act on what they know.

A research publication, www.uptodate.com is now available to all residents in practice. What it implies is a change as well. The Chief Resident or Esteemed Doctor always knew it all and now the role of physician is changing. The doctors are mentoring a decision making process with their residents, teaching and patients and no one is right and no one can prescribe without a style of communication on complex health matters that include everyone respectfully and permits disagreement as part of learning to know to do.

[Chris Young]

Glad to hear the medical industry is aware of the need to improve patient care by examining the way workplace bullies impact the care a patient receives.

I featured your post as one of my top blog picks for the past week which can be found here: http://www.maximizepossibility.com/employee_retention/2008/07/the-rainmaker-1.html

Be well!

Chris Young