Among healthcare leaders, there has been a call to arms of sorts, which has swelled over the last five or so years, to rid medicine of, well, jerks.
The more technical term we've been using to describe this phenomenon of clinicians (mostly physicians) who are condescending, argumentative, aggressive and/or refuse to play well with others is "disruptive medicine."
In 2008, The Joint Commission created a new policy classifying disruptive behavior as a sentinel event, urging the organizations it accredits to take a zero-tolerance approach toward such situations.
According to TJC, disruptive behaviors include "overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities."
Research has shown that both overt and passive behaviors are not rare (98 percent of healthcare workers reported observing such behavior, according to a study by the American College of Physician Executives) and can be detrimental to patient safety.
As a result, healthcare systems across the country have cracked down on disruptive behavior, choosing to cite physicians rather than looking the other way — the typical response by administrators for many years. In extreme cases, hospitals have dropped credentials or fired physicians for disruptive behavior.
At the same time, Medicare and commercial payers have begun to reward clinicians for strong patient satisfaction scores. Physician groups have also begun compensating clinicians based on their scores. In rare cases, clinicians with the lowest scores could be dropped from networks or fired.
Despite trends toward kinder, more empathetic, clinicians, Wen Shen, MD, an endocrine surgeon at the University of California-San Francisco, says the push for "a kinder, gentler surgeon" is misguided.
"My profession is filled with exceptional individuals who do amazing, lifesaving work. Many of us are jerks," Dr. Shen writes in an article for Pacific Standard, a publication put out by the Miller-McCune Center for Research, Media and Public Policy. "This is the trouble with surgeons. We are a sub-tribe of doctors who have long been celebrated for our abilities yet reviled for our personalities."
"Within the past two decades, though, the surgical profession has attempted a wholesale revamping of its image and ideals. Compassion, communication, and collaboration are now strongly emphasized during training. It’s been a rapid and turbulent metamorphosis that has undoubtedly led to improvements for patients, hospital co-workers, and even surgeons themselves. Nonetheless, in the process, surgery may have created its own identity crisis. We want to believe we’re better off with nicer surgeons. But what do we lose?"
While Dr. Shen admits many of the effects have been positive — a 2011 survey that found patients who perceive higher levels of empathy in their surgeon have better outcomes — he worries our industry's push for more likeable surgeons may have unintended consequences.
Has our emphasis on patient satisfaction gone too far?