“Physician, heal thyself.”
Now that healthcare employers take disruptive workplace behavior seriously, and a major survey has indicated that physicians cause the majority of it, what are they doing to change the situation?
According to Dr. Barry Silbaugh, CEO of the American College of Physician Executives (ACPE), one effective method is based on the engineering concept of high reliability. “This sticks more with doctors because they think like engineers,” he says.
“There is a fair amount of overlap between disruptive behavior and medical malpractice,” Silbaugh says, although he knows of no studies examining the exact relationship.
With lives and health on the line, the healthcare field is following the aviation industry, which several decades ago brought in the principles of high reliability to improve behavior among pilots and crew in airplanes, where lives are also at stake.
The ACPE works with physicians all around the country, teaching them how high reliability applies to the practice of their profession. “We try to emphasize the knowledge and behavior competencies needed by physician leaders,” he says.
The most dangerous time for patients is when they are transferred from one department to another, such as the operating room to intensive care, Silbaugh says. “Doctors need to learn how to behave and influence people,” he adds. “They must let go of autonomy and become part of a team” that feels free to ask questions about patients and their care without fearing attacks or reprisals.
Another huge issue for physicians is admitting that they are not perfect, that they will make mistakes. In addition, Silbaugh notes, the obsessive-compulsive behaviors that may have helped them through medical school start to work against doctors in the real world of actual medical practice.
“Medical schools use too much humiliation as part of their training,” Silbaugh adds. He says that when he speaks to doctors, he talks about the baggage they carry with them, and always cites poet Maya Angelou, who writes that people never forget how we make them feel. Amen to that.
The real issue, however, goes beyond behavior, which is visible and measurable, and is therefore usually the focus of improvement efforts. Behavior, in its turn, arises out of our feelings about self and our beliefs. The baggage, in other words.
Doctors, nurses, and other healthcare professionals dishing out disruptive, possibly criminal behavior do so out of low self-esteem. They feel bad about themselves and are insecure, and take it out on those around them. They also play politics, jockeying for position and recognition. All at the expense of patients and colleagues.
How do we heal feelings? How do we even find them within ourselves to address them? The low self-esteem and insecurities that prompt disruptive behavior are often not available to our conscious awareness. We cannot fathom why we act the way we do. It just comes out and blindsides us as well as those around us.
The irony of medicine today is that having devolved into a science devoted strictly to the physical, there is little accounting for the mental part of self, and no place at all for the emotional and spiritual aspects of our being.
Yet if physicians (and the rest of us) are ever truly to heal themselves or their patients, they/we must finally include the overlooked parts of self that cry out for succor. The emotional and spiritual are just as real and valid as the physical and mental sides of self, or our behavior. Feelings and beliefs are powerful and important.
Yet medical science ignores and leaves behind this entire half of self, rendering healthcare incomplete and ever more costly as a result.