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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Physicians tell us they're seeing more frequent incidents of other doctors acting disrespectfully toward patients or coworkers, too casually about patient privacy, angrily or aggressively at work, and sometimes even criminally. Such behavior is still relatively uncommon, and many respondents say they are proud of the high standards of attitudes and behavior shown by fellow physicians. Some physicians feel that the public holds them to an overly high standard for behavior that has nothing to do with treating patients.

Medscape surveyed more than 1500 doctors about how often and where physician misbehavior crops up today, and what they've witnessed or experienced with other doctors in recent years.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

We asked physicians about inappropriate behavior by doctors (unprofessional or disrespectful behavior toward patients or colleagues, disregard for patient privacy, angry or aggressive acts, or lawbreaking). They reported spotting misbehavior at work somewhat more often than in our 2021 report.

While that uptick is not substantial, "I have increased concern for my colleagues" over its implications, says Drew Ramsey, MD, an assistant clinical professor of psychiatry at Columbia University. "People forget that COVID has made the physician workplace incredibly stressful. Physicians are struggling with their mental health" and it's even harder for women doctors, who also have faced years of discrimination at work.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Lots of respondents complained about physicians posting COVID-19 misinformation or objectionable viewpoints online. But there were other examples too.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

When physicians are asked only about their own behavior, their views become more moderate. Eighty-five percent of respondents, about the same as in last year's report (87%), answered "no" when asked if they behaved poorly as a physician — knowingly or mistakenly — during the past year.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

The number of doctors who see inappropriate physician behavior is one way to look at the issue. Another is how many instances each sees. On average, respondents say they witnessed or experienced seven instances of inappropriate or bad physician behavior over the past 5 years, about the same as in last year's report (six).

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Respondents were asked whether they had personally witnessed certain misbehaviors by physicians in the past 5 years, and if so, which misbehavior they saw most recently.

Generally, Ramsey thinks these results are affected by "greater awareness of what harassment and bullying in the workplace looks like. Five years ago, we weren't talking about microaggression."

On the other hand, doctors say they witnessed physicians mistreating other medical personnel, bullying or harassing patients, and committing crimes somewhat more often than in last year's report. The comparable figures in the 2021 report were mistreatment, 80%; bullying, 38%; and crimes, 19%.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

In our 2021 report, 68% of respondents had seen disparaging behavior and 45% had heard racist language. Last year, 58% of respondents said they witnessed inebriated doctors in public. "A partner of mine was inebriated at a party and started pawing a woman — not his wife," one said. "A group of doctors at a concert were being loud and rude while inebriated," another added.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Encouragingly, the share of physicians who said they did nothing at all declined somewhat since our 2021 report (35%). Physicians most often chose to either confront another doctor about their misbehavior or report the incident internally at work. The frequency with which physicians chose various alternative actions hasn't changed much from last year's report.

The American Medical Association reminds physicians that a Code of Medical Ethics opinion recommends that they report incompetent or unethical behavior that could put patients at risk.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Physicians have been consistent in our reports and most often favor verbal warnings, manager interventions, filing an internal report, or issuing a disciplinary letter when another doctor misbehaves at work.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

As in last year's report, the offenders were more often physicians in their 40s, followed fairly evenly by doctors in their 30s or 50s. This could include physician misbehavior witnessed or experienced at or away from work or on social media.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

As in last year's report, female physicians were witnessed misbehaving about one third as often as their male counterparts were.

"Women in medicine haven't had much of an opportunity to behave badly because they're fighting just to receive equal opportunity," Ramsey believes. "Also, some misbehavior stems from alcohol abuse, and a higher percentage of men have an alcoholism problem. Also, male physicians have historically been reluctant to seek mental health assistance."

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

A substantial majority of physicians feel that they should have higher standards of behavior than what the general public faces, based solely on their profession. While that majority has shrunk since last year's report, a Journal of Medical Ethics blog notes that loftier moral and personal conduct standards for physicians are rooted in centuries of tradition. And various medical organizations' ethical codes emphasize respect in personal interactions.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Addressing what they think are the general public's expectations for physician behavior, more doctors think those standards are set too high for behavior outside their medical offices vs inside.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

The three factors cited most often were generally similar to last year's results. Job-related stress and the mental strains of COVID-19 were faulted somewhat more often than in the 2021 report (41% and 18%, respectively).

Ego issues "should point our medical educators to where we need help in the field," Ramsey says. "It speaks to the profound insecurity many physicians feel today, battling with electronic medical records and administrators and RVUs, among everything else."

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Most doctors continue to believe that they should be able to behave as they wish in their personal lives, as long as they aren't acting in a professional capacity.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Doctors are clearly concerned about the impact of misbehavior and how it may affect the public's perception of their profession. A strong majority (although less than in last year's report) agrees with the idea that one doctor's misbehavior can have a ripple effect on the entire medical profession.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Many doctors say they favor various kinds of disciplinary action against misbehaving physicians — but most also concede that it isn't happening often. About two thirds of respondents say they haven't witnessed or experienced company or medical board action for inappropriate public behavior by physicians.

Physician discipline in America has long been criticized for inconsistency. The percentage of doctors who are disciplined for misbehavior is four times higher in some states than others, according to a University of Michigan study.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Many people characterize social media as open season for the worst kind of behavior. But nearly two thirds of doctors see more physician misbehavior happening in personal interactions — either at or away from work — than on social media platforms.

One study indicates that this could be because doctors behave more carefully online. There may also be an age-related component; students at the medical school studied reported self-posting unprofessional content more often than their older faculty did.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

How often do physicians witness misbehavior by other doctors on social media? The number of instances that respondents can recall from the previous year has held steady since our 2021 report.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

As in last year's report, inappropriate commenting is far and away the leading source of physician misbehavior on social media seen by fellow doctors. The percentages for each category of social media hijinks held fairly steady from our 2021 report.

Here are a few posting gaffes mentioned by survey respondents:

"Someone got fired and stalked the supervisor and posted aggressive things."

"A physician posted pictures of herself at a bar with multiple ER staff members, without masks during COVID restrictions."

"Unbelievable, anti-scientific information expressed as valid, factual material."

"Copying and posting an interoffice memo from work and badmouthing the company and the person who wrote the memo."

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Facebook and Instagram continue to be the leading vehicles for instances of questionable physician behavior, according to doctors who use social media at least three times weekly. "I see bad behavior almost every time I read an active post on Facebook or Instagram," one survey respondent says. "There are always hotheads who enjoy attacking people of opposing viewpoints."

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

"What exactly is bad behavior?" one respondent asks. "If you're saying physicians should be allowed to sexually assault people and use drugs, then no. Can they wear a tiny bathing suit on vacation and drink cocktails with friends? Yeah."

Both the age distinction (younger physicians are substantially more liberal about posting some photos) and the individual percentages are about the same as in our 2021 report.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

The great majority of physicians are careful to avoid posting inappropriate selfies or other photos that also show medical practice settings. The number of "no" responses to posting inappropriate selfies is about the same as in our 2021 report (88%). "Don't take selfies that do not respect HIPAA regulations for patient privacy," one respondent warned.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

Only 1 in 10 physicians have friended/followed a patient on social media or might. There are both common-sense and professional privacy/ethics reasons to avoid doing this. For example, the American College of Surgeons urges members to refrain from friending patients and to keep online communications limited to a healthcare portal.

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

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Physicians Behaving Badly: Stress and Hardship Trigger Misconduct

Jon McKenna | August 19, 2022 | Contributor Information

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Physicians' Views on Today's Divisive Social Issues Report 2022: Strong Emotions, Contrary Opinions

Physicians reveal their attitudes about 10 of today's hottest social issues, from racial disparities to gun control, and how those challenges affect their lives and practices.
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