Abusive doctors: 'Health care equivalent of road rage'

By LAURIE TARKAN, New York Times

Last update: December 1, 2008 - 8:32 PM

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It was the middle of the night, and Laura Silverthorn, a Washington nurse, knew her patient was in danger.

The boy had a shunt in his brain to drain fluid, but he was vomiting and had an extreme headache, two signs that the shunt was blocked. When she paged the on-call resident, who was asleep in the hospital, he told her not to worry.

After a second page, Silverthorn said, "He became arrogant and said: 'You don't know what to look for. You're not a doctor.'"

He ignored her third page, and after another harrowing hour she called the attending physician at home. The child was rushed into surgery.

"He could have died or had serious brain injury," she said.

Her experience is borne out by surveys of hospital staff members, who blame badly behaved doctors for low morale, stress and high turnover.

Recent studies suggest that such behavior contributes to medical mistakes, preventable complications and even death.

"It is the health care equivalent of road rage," said Dr. Peter Angood, chief patient safety officer at the Joint Commission, the nation's leading independent hospital accreditation agency.

A survey of health care workers at 102 nonprofit hospitals from 2004 to 2007 found that 67 percent of respondents said they thought there was a link between disruptive behavior and medical mistakes, and 18 percent said they knew of a mistake that occurred because of an obnoxious doctor. (The author was Dr. Alan Rosenstein, medical director for the West Coast region of VHA Inc., an alliance of nonprofit hospitals.)

Of course, most doctors do not spew insults or intimidate nurses. "Most people are trying to do the best job they can," said Dr. Joseph Heyman, chairman of the trustees of the American Medical Association.

Dr. William Norcross agreed. He is director of a program at the University of California, San Diego, that offers anger management for physicians. But he added, "About 3 to 4 percent of doctors are disruptive, but that's a big number." Experts say the leading offenders are specialists in high-pressure fields such as neurosurgery orthopedics and cardiology.

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