COMMENTARY

Doctors' Unrelenting Stress Can Lead to Bad Behavior

Arthur L. Caplan, PhD

Disclosures

November 10, 2015

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Hi. I'm Art Caplan at the Division of Medical Ethics at NYU Langone Medical Center. We've seen a rash of very disturbing reports lately about physician conduct inside the surgical theater and inside the intensive care unit (ICU), and that conduct is obviously inappropriate.

Recently, the Annals of Internal Medicine published an article[1] that anonymously described two cases—one involving a woman who was bleeding out after having a baby, and another who was facing a hysterectomy—in which physicians acted extremely inappropriately toward these patients as they were getting ready for their operations. They basically had sexual touching and joked about the patient as to whether they were involved in sexual activity. Completely inappropriate, completely wrong, stunningly awful behavior. Obviously, people began to discuss how this could happen.

I have to tell you, the first reaction I had—and the reaction that many people had—is that this is unethical. Maybe we ought to redouble our efforts in ethics training for doctors. If they're going around making bad, inappropriate jokes or touching people inappropriately, then somehow they missed the ethics class. But I don't think that's the problem.

I think it's clear that if you confront anybody about this behavior, they'd have to say that it's wrong. I don't think you're going to somehow convince someone in an ethics class that making bad jokes and inappropriate sexual contact isn't unethical. That isn't what they need to hear. They know that.

What I think is going on is that we're not giving enough support to people who are often practicing under a lot of tension—facing almost posttraumatic stress disorder (PTSD)-type circumstances—and may be afraid to ask for help.

When a doctor acts up in these egregious ways, I think their colleagues have to be on the lookout and say, "Look, you can't behave that way. I think you'd better get some help if you can't cope with the tension or the stress of what's going on here. You may need to learn how to get some more self-control, get some support."

I think we underestimate the degree to which being a doctor in very tough circumstances can take an emotional toll. It really can be stressful. It really can be hard.

I don't think we provide enough counseling or the opportunity for support to people. We expect people to macho it out and sort of deal with the tension, deal with the trauma, and deal with the mental stress. It's obvious from these reports that some people don't do well. I think we've got to offer them more help.

So, as much as I'd like to say, "Aha! Here's a lot of bad behavior. Time to do more medical ethics," that isn't the conclusion I would reach. I think what this tells us is that it's time to offer more support, time to offer some preventative psychological interventions, and time to be on the lookout to see whether your colleague is getting just too stressed out and needs some help.

I'm Art Caplan at the Division of Medical Ethics at the NYU Langone Medical Center.

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