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Physicians admit to unprofessional behavior reports new study

Robin Wulffson MD's picture
unprofessional behavior, hospitalists, patient care, hospital care

Medicine is often termed as a noble profession in which doctors are viewed as caring individuals who devote their life to healing.

However physicians are fallible and can exhibit inappropriate behavior. Researchers at three academic hospitals in Chicago conducted a survey to determine how their hospital-based physicians (hospitalists) measured up in regard to professional conduct. The doctors surveyed frequently admitted to unprofessional behavior such as badmouthing fellow physicians and finding medical excuses to avoid having to care for patients. The results were published in the current edition of the Journal of Hospital Medicine.

Hospital medicine is a specialty focused on the medical care of acutely ill hospitalized patients. Physicians whose primary professional focus is hospital medicine are called hospitalists. Hospitalists act as transition coordinator and case managers for the patient’s physician. Since they are hospital-based, they are readily available when an emergency arises. Physicians in training (residents) perform the duties of hospitalists in academic hospitals.

To evaluate the degree of unprofessional behavior, the researchers conducted a survey based on the Leikert Scale. A Likert Scale is a type of psychometric scale frequently used in psychology questionnaires. A typical Likert item usually takes the following format: strongly disagree; disagree; neither agree nor disagree; agree; or strongly agree.

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A total of 101 hospitalists were surveyed; the response rate was 77/101 (76%). Nearly all behaviors were perceived as unprofessional (“unprofessional” or “somewhat unprofessional” on the Likert scale). Participation in extremely egregious behaviors was low. Falsifying medical records was less than 5%, and performing medical or surgical procedures on a patient beyond self-perceived level of skill was 2.60%. The most frequent unprofessional conducts reported were having personal conversations in patient corridors (67.1%), ordering a test as “urgent” to expedite care (62.3%), and making fun of other physicians (40.3%). Four factors accounted for 76% of unprofessional behaviors: (1) making fun of others; (2) learning environment (i.e., texting during conferences); (3) workload management (i.e., celebrating a blocked admission); and (4) time pressure (i.e., signing out work early). Blocking an admission refers to refusing to accept a patient into their unit by claiming the patient should be cared for in another part of the hospital. “Turfing” was reported at 9%; the term refers to transferring a patient that a physician was capable of taking care of, but was switched to another doctor’s care to reduce their patient load.

An interesting––but not surprising finding––was that more hospitalists reported seeing another physician act unprofessionally than they admitted they did themselves. For example, 68% reported that they had witnessed another doctor “blocking” a patient eight times more often than physicians who admitted to doing the blocking. In addition, almost 20% of doctors said they had observed a patient being discharged before they were ready to go home, while only 2.6 percent admitted to doing that.

Hospitalists with less clinical time (less than 50% ) were more likely to report making fun of others. Younger hospitalists and those with administrative time were more likely to report participating in workload management behaviors. Hospitalists who work night shifts were more likely to report participating in time-pressure behaviors. The researchers noted that workload management and learning environment varied by site.

The authors noted that observations of unprofessional behavior can be skewed because doctors may not grasp the full context of a situation or because more than one doctor can report seeing the same incident; thus, inflating the number. The study focused on rates of unprofessional actions that doctors admitted to participating in because those are of more importance to the officials who are involved in the training of professionalism for doctors and residents.

The authors concluded that hospitalist participation in unprofessional behaviors is low; however, job characteristics (clinical, administrative, nights), age, and site were associated with different types of unprofessional behavior that may affect the learning environment and patient care.

Reference: Journal of Hospital Medicine