Anonymous Reporting May Help Spot Disruptive Physicians

Kerry Dooley Young

February 23, 2018

Anonymous reporting tools, such as online surveys and paper drop boxes, can help hospital officials and managers of medical practices spot cases of disruptive behavior by physicians, a consultant said in an industry-sponsored webinar on Wednesday.

Many medical professionals still fear repercussions from alerting supervisors and executives about physicians and other colleagues whose behavior is hostile, despite major efforts in recent years by influential medical groups to address this long-standing issue in medicine, according to Catrena Smith, owner of Access Quality Coding and Consulting, LLC.  Speaking in a Wednesday webinar arranged by The Compliance Connect, Smith said staff in hospitals and medical offices worry about reprisals that could affect their jobs and future compensation.

"We want to create an environment where they can openly discuss things," Smith said in the webinar.

She cautioned against assuming that all anonymous reports of disruptive behavior are valid. Inaccurate complaints can stem from misunderstandings and even malice.

Still, anonymous reporting is "one of the best tools you can use" to learn about disruptive behavior, Smith said in a follow-up interview with Medscape Medical News.

"People tend to be more open. No matter how much we tell them that there's not going to be retaliation, sometimes people still fear there will be," she said.

For at least a decade, the medical profession has faced serious calls to address a culture that often coddled abusive behavior by physicians, such as throwing charts or instruments at nurses or dressing down other colleagues.

In 2008, the nonprofit Joint Commission (JCO) moved to tackle what it terms "behaviors that undermine a culture of safety," leading to the development of standard that requires hospitals to have a code of conduct as well as a process for managing disruptive and inappropriate behaviors. In a 2013  blog post on the JCO's initiatives to address disruptive behavior, the organization's then medical director, Ronald M. Wyatt, MD, MHA, cited research that found 17% of survey respondents had felt pressured to accept a medication order despite concerns about its safety on at least three occasions in the previous year.  Another 13% reported refraining from contacting a specific prescriber to clarify the safety of an order on at least 10 occasions, Dr Wyatt wrote.

"While disruptive and intimidating behavior can be displayed by nurses, pharmacists and managers, it is the behavior of doctors which most often causes problems, perhaps because medical culture has had a history of tolerance or indifference to this, or because organizations have tended to treat doctors differently from other staff," Wyatt said.

In the Wednesday seminar, Smith also stressed the need for hospital leaders to impose equal demands on behavior for people in all departments.

"We can't say, 'Well, these folks over here in medical records, if they curse somebody out, then we're going to terminate them immediately and that's that, but if you work on the medical staff and you curse somebody out, then we'll give you a warning, we'll send you to some interdepartmental training and maybe we'll give you another chance,'" Smith said.

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