“Physician, heal thyself.”

–Luke 4:23

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.

These medical “professionals” relegate notorious TV physician Gregory House to strictly amateur standing.

A recently published survey of more than 2,100 U.S. physicians and nurses reveals that almost 98 percent of them have witnessed serious incidences of unprofessional conduct that crosses into criminal behavior while on the job in hospitals and other healthcare workplaces.

The kinds of actions cited are not merely the snide remarks that the fictional House directs at colleagues, friends, patients, and other unsuspecting targets. The abysmal conduct includes groping a radiology technician while she was taking an X-ray. A nurse spreading false rumors about a new physician to get him fired or disciplined. One enraged surgeon tossing surgical instruments about an operating room and another shoving a nurse into a trash bin head first. A different physician telling a nurse, “You don’t look dumber than my dog. Why can’t you at least fetch what I need?”

The most common grievance from the survey: degrading comments and insults, which nearly 85 percent of participants reported they had experienced at their organization. Other frequent complaints included yelling, cursing, inappropriate joking, and refusing to work with one another.

Most of the survey participants (67.2 percent) were nurses, and 32.8 percent were doctors. While there were reports of bad behavior among nurses, most respondents, nurses and doctors, cited physicians as the primary source of the problem. While most (56.5 percent) said the incidences occurred either monthly or several times a year, 30 percent said they occur weekly and 9.5 percent reported witnessing problem behavior daily. In other words, more than one-third of surveyed healthcare professionals encounter poor behavior as a regular part of their workday.

This disruptive behavior negatively impacts patient safety and saps workforce morale, according to Dr. Barry Silbaugh, CEO of the American College of Physician Executives (ACPE), which conducted the survey. “It’s nothing new,” Silbaugh says about the conduct brought to light by the poll.

Indeed, anyone who has family or friends in the healthcare field has heard plenty of similar horror stories. I attended college with a registered nurse who graduated from the last nursing diploma class admitted to the profession. She was back in school to obtain the four-year degree that had been just been established as a requirement to become a nurse. It was the early 1970s.

My college classmate often regaled me with toe-curling tales about how she spent much of her time on the job trying to keep interns and residents from harming patients because of their inexperience and/or arrogance. Her view was confirmed by a good friend from later in life who is also a registered nurse and reported much the same situation. Both women are no longer working as nurses, which is hardly surprising.

Then there is the report from the hospital trenches about a different surgeon well known among his colleagues for temper tantrums. One time during a procedure he threw a scalpel. The sharp knife hit something and ricocheted back at him, slicing into his palm and ending his career in the operating room. Instant karma?

While the situation has festered for decades, it has taken on fresh urgency for several reasons, Silbough explains. The first is the current national emphasis on healthcare reform. Despite notable improvements at certain organizations, he says, the majority of healthcare systems still struggle with disruptive behaviors by doctors, nurses, and other medical professionals.

Another reason for renewed interest in solving the problem is a requirement instituted at the start of 2009 by the Joint Commission, the most highly regarded medical accreditation organization. Hospitals and other healthcare facilities must now show a written code of professional conduct to earn Joint Commission safety accreditation.

According to those who replied to the questionnaire, the fundamental issue behind much of the behavior problem is lack of respect between doctors and nurses. And there is good news in all of this. Members of the profession and professional groups like the ACPE are finally starting to talk openly about the problem and address it, instead of keeping it as healthcare’s dirty little secret. And there are actions that members of the healthcare field can take to reduce the problem.