When results of a confidential survey of nurses were presented to the 350 doctors on staff at Hoag Memorial Hospital in Newport Beach, Calif., "these guys sat there with their mouth open," says Richard Doering, M.D., who was chief of staff at the time.
The hospital survey, compiled in 2000, recounted incidents when physicians--mainly surgeons--yelled at nurses, threw things at them and behaved so badly that some nurses thought of quitting.
The doctors "didn't realize the effect they had on nurses when they barked at them," Doering says.
Driving Nurses away
After years of quietly tolerating temperamental physicians and often ignoring nurses' complaints about them, hospitals like Hoag are cracking down on doctors who abuse nurses either physically or verbally.
In a new survey by VHA, a national alliance of community hospitals based in Irving, Texas, 92% of responding nurses, doctors and administrators at VHA hospitals say they have witnessed disruptive physician behavior.
The survey, published in the June issue of the American Journal of Nursing, finds that relatively few doctors are disruptive, but colleagues tend to excuse their behavior.
Moreover, the survey shows that 30% of the nurses polled knew at least one nurse who resigned because of physician behavior--an especially troubling statistic during a chronic nursing shortage.
"If physician behavior is contributing to the nursing shortage, that's bad, because we know the nursing shortage is linked with poorer patient care," says Alan Rosenstein, M.D., who is the author of the study as well as vice president and medical director of VHA West Coast in Pleasanton, Calif.
His survey identifies surgeons as the worst offenders.
While 3% of nurses complained about doctors in most specialties, at least 17% complained of doctors in cardiology and cardiac surgery, neurology and neurosurgery, and general surgery, Rosenstein reports.
Whistle blowers vs. instrument throwers
Until recently, physicians' disruptive behavior "was always swept under the carpet," Rosenstein says.
Indeed, he adds, many nurses in the survey report that their complaints about disruptive physicians went unheeded.
Doering concedes that "this is the toughest issue you have to deal with" as chief of staff. "It's unpleasant."
During his two-year stint as chief, Doering forced doctors accused of disruptive behavior to meet with him and threatened problem doctors with loss of privileges.
The doctors got "angry and red-faced" and protested that the real problem was incompetent nurses, he recalls.
Rosenstein thinks physicians learn to accept bad behavior while they're on medical school internships.
"They think you have to be very autocratic and domineering, because that's the way you're treated as a medical student," he says.
Doering, a vascular surgeon, observes that surgeons are "by nature aggressive people, and they have high expectations of themselves and their teams. In the OR, they are the team leaders, and when something goes awry, they bring it up."
It's common to see surgeons "blow off steam, and once in a little while someone throws an instrument," he continues.
But Doering has seen behavior improve after introducing stricter monitoring, a code of conduct and more opportunities for nurses and physicians to interact.
In fact, he says, one of the disruptive doctors at Hoag eventually was elected "doctor of the month" by nurses.