Disruptive behavior linked with safety problems

October 8, 2015

The Washington Post ran an article about a Tel Aviv University study of the effects of physicians’ disruptive behavior on patient safety.  As discussed in previous posts, there is a clear link between disruptive behavior among physicians (and other professionals) and negative patient outcomes.  The coworkers who are often the target of or witness to disruptive behaviors typically avoid their disruptive colleague.  This avoidance is understandable but can significantly break down communications among treatment teams.  When the different members and disciplines within a treatment team do not candidly interact with each other bad things happen: nurses don’t confront physicians’ mistakes, wrong-sided surgeries occur, etc.  Disruptive behavior must be taken seriously and assertively addressed by leadership.

Forgiveness and Forgiving the Unforgivable

June 24, 2015

Over the years of doing psychotherapy with individuals and couples I have often observed a thematic trend from patient to patient. Sometimes I get a bunch of calls about relationship problems or several existing patients will bring up similar issues in the same week or even the same day. Lately I have noticed that I am talking with a bunch of folks about forgiveness. Often the historical issue that my patient is struggling with is an “unforgivable” event but we still find ourselves discussing what forgiveness means or what it looks like. I like to think about forgiveness as being a selfish – rather than a selfless – process. Sometimes we forgive people, not for them but, for ourselves.

Think about the amount of time, energy and emotion you devote (and continue to allocate) toward maintaining resentments, being angry and keeping hatred alive. Now imagine how liberating it would be to be able to let go of that and how you might reallocate that time, energy and emotion. I’m sorry, but I don’t have any magical answers about how this process unfolds other than to say that it is just that: a process, and it begins by talking about the transgression against you. Eventually you may or may not opt to have a conversation, write a letter or engage in some sort of symbolic gesture to “interpersonally” forgive your transgressor. I recently read an interesting article in the Huffington Post about forgiveness but the most inspiring thing I’ve come across regarding the concept of forgiveness was a great story on NPR’s The Story (scroll down to the second story and if you want to listen to the show, you can skip the first third of the mp3 file).

Does empathy matter

March 13, 2015

As a psychologist, this is no surprise to me, but medical schools and physicians’ residency training programs are concluding that empathy (understanding the patient’s perspective and effectively communicating that understanding to him or her), in fact, matters quite a bit.

Programs Aimed At Equipping Doctors With Empathy See Yielding Results.

In a nearly 1,650-word piece, Kaiser Health News Share to FacebookShare to Twitter (3/13) reports efforts to teach doctors about empathy is yielding results, citing the example of a Jeremy Force, a first-year oncology fellow at Duke University Medical Center. Force put into practice what he learned in “‘Oncotalk,’ a course required of Duke’s oncology fellows,” consequently earning praise from a patient suffering from breast cancer. The article notes “clinical empathy was once dismissively known as ‘good bedside manner’ and traditionally regarded as far less important than technical acumen.” However, “a spate of studies in the past decade” has come to the conclusion that “it is no mere frill,” and empathy “is considered essential to establishing trust, the foundation of a good doctor-patient relationship.”

Should you really be scared of antidepressants?

November 11, 2014

For the past decade some of the “newer” antidepressants have had “black box warnings” that caution about a risk of suicidal thoughts and behaviors in young adults and kids.  Though there has been controversy about this, the benefits and risks of these easily misinterpreted warnings is finally being looked at a bit more closely again (but not by the FDA yet).  See the TIME story or an article in the New England Journal of Medicine for more information.

Physician Fitness for Duty Evaluations

September 19, 2013

I just found an interesting article that is still in-press about fitness for duty evaluations for physicians.  A significant part of my practice is devoted to assessing and addressing issues related to physician (and other professional) impairment and disruptive behavior.  Much of the consulting I do is with licensing boards, professional associations, hospitals and practices, so this article was of great relevance to my practice.  One of the findings that I was particularly pleased to read was that the authors noted that of the physicians they evaluated, most of the time those referred for “disruptive” behavior were assessed as being fit for duty.  This is consistent with the majority of my findings; however, this should not be misinterpreted as saying that there are not very significant potential risks and dangers of disruptive conduct within the workplace.  In fact, this is precisely what makes it so difficult to perform fitness for duty evaluations for disruptive professionals: though such healthcare providers may not be impaired personally, the effects of their behaviors may (and often do) negatively affect the safety and efficacy of their colleagues performance.  So while the disruptive physician may be assessed as being fit, her disruptive behavior may still pose significant problems to the overall functioning of the work environment including compromising patient safety.

Doctors Lie?

March 29, 2012

There was a very nice, honest piece in the Op-Ed section of the NYT recently about doctors’ feelings and why they lie (or don’t tell the whole truth) to their patients.  The physician/author candidly shared some very personal feelings and stories about when she wasn’t able to tell her patients the truth and when she actually lied to them.

Many physicians (and the attorneys who counsel them) believe that if they give bad news or, even worse, if they admit to committing a medical error, they will be the subject of a malpractice law suit.  Interestingly, however, the data suggests otherwise: patients rarely sue doctors who they like and who are honest with them.  Think about it: its no surprise that patients are more likely to sue their doctor when they find out that the doctor messed up and covered up something while caring for them.  In contrast, when someone frankly and honestly apologizes to you for making a human error, you are far more likely to forgive them.

Perhaps honesty really is the best policy.

Physician Wellness

March 8, 2012

I just read an survey study about the health and well-being of medical residents that was done by a chief resident at a local Baltimore hospital.  The article describes the well-known difficulties that residents face such as sleep deprivation, social isolation, etc.  Then they looked at health-related behaviors including seeking medical or psychiatric care.  Not surprisingly, most medical residents reported not having a primary care physician, not calling out when they were sick and not seeking emotional support.  Perhaps even more disturbing than these results was the fact that many did not disclose information to their treatment providers (when they did seek treatment) or did not seek treatment because of fears of confidentiality breaches.  It’s a sad statement when doctors do not trust fellow doctors to keep private their personal information.

Changing definitions

November 23, 2011

On November 9, 2011, the Joint Commission announced that they will be changing the definition of the term “disruptive behavior.”  Specifically, they have noted that disruptive behavior is “behavior or behaviors that undermine a culture of safety.”  They added that term is not viewed favorably by some and that many find it to be ambiguous.  Though I surely agree with this, I do not foresee an large, wide-reaching entity such as the Joint Commission being able to define a very complex range of behaviors in a way that covers all it needs to cover without going too far.  When I give talks about disruptive behavior and workplace violence I often suggest that (unfortunately) the classification of one’s behavior as being disruptive “lies in the eyes of the beholder.”  There’s no way the Joint Commission (or even a hospital, small practice or company) could get away with that.

Cause and Effect

May 26, 2011

I just watched an interesting presentation by the American College of Physician Executives on the Causes and Effects of Disruptive Behaviors.  It was a nice, short presentation that addressed the prevalence and the impact of disruptive behavior among physicians.  Interestingly, in their study, 99% of the individuals surveyed reported patient-safety implications secondary to a doctor’s disruptive behavior.

From a nurse’s perspective

May 10, 2011

The NYT ran a nice Op-Ed piece written by an oncology nurse about the impact of disruptive behavior on her morale, communication and, most importantly, patient safety.  Unfortunately this nurse’s experience is not uncommon.  I hear similar stories practically every day.  What made this nurse’s experience different was the callousness of the physician who proudly told her that she could quote him in the piece; in my experience working with physicians, nurses, psychologists, executives and other professionals is that they typically don’t intend to be disruptive, hostile or abusive.  We all know, however, that intention and perception are two different things.  We often mean no harm but still inflict considerable damage upon those around us.

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