Surgeons and physicians who perform clinical procedures (such as endoscopies and biopsies) receive the most co-worker complaints about unprofessional behaviour finds study. A survey of over 35,000 medics reveals that surgeons top the charts for reports of unprofessional behaviour, while paediatricians come out as the least complained about.
In a research paper published late last year in the medical journal, JAMA1, researchers used an electronic system to track colleague initiated complaints from between 2018 and 2022. This study aimed to identify whether there exists an association between improper conduct and different clinical specialities.
Doctor Doctor Give Me the News
Due to the nature of their work, we demand that medical doctors uphold high levels of professionalism, compassion, integrity, trustworthiness and discernment2. Technical reporting of malpractice and legal suits are no novelty in the world of medicine, and investigating possible errors is vital to an evolving and improving practice. When it comes to clinician behaviour, however, there has historically been less emphasis on interpersonal conduct in hospitals.
In this study, researchers led by William Cooper at the US’s Vanderbilt Center for Patient and Professional Advocacy (CPPA) based out of Vanderbilt’s University Medical Center’s Department of Pediatrics, opened a window into this hidden side of medical practice.
Documenting the doctors
The team used the Co-worker Concern Reporting System (CORS) to track reports submitted by physicians about the professional conduct of their colleagues. The study involved 35,120 medics across 193 hospital and practice sites enrolled in the CPPA program. These facilities routinely send electronic reports about inappropriate behaviour. The identities of the doctors in the reports were removed, and the concerns grouped by medical speciality.
Out of over 35,000 doctors studied, just one in 11 had a co-worker raise concerns about their professional behaviour. Surgeons topped the list, with around one in seven flagged for unprofessional conduct. Non-surgeon proceduralists came next (1 in 8), and then emergency medicine doctors (1 in 10). Interestingly, medical staff were least likely to report problematic behaviour by paediatricians. The investigation highlighted that the most common concerns arose from issues involving respectful communication (such as a doctor snapping at an assistant or taking a correction offensively), followed by doubts about professional integrity.
A Surgical Approach to Unprofessional Behaviour
The investigation revealed that surgeons and doctors performing procedures (proceduralists) are the most likely to have reports filed about them.
On the other hand, the research team including paediatricians from Vanderbilt University Medical Center; Department of Pediatrics, Stanford University School of Medicine; Departments of Emergency Medicine and Paediatrics, University of Michigan Medical School and Arkansas Children’s Hospital, says they discovered that paediatricians are least likely to be reported for bad behaviour.
The authors of the study suggest that this can be ascribed to the nature of the work. Surgeons and non-surgeon proceduralists work in the most high stress settings. Picture the operating room. A large team of healthcare workers are engaged in a high-stakes procedure with no margin for error. In these environments, people can get frustrated, and emotions can run high.
These findings could also shed light on the personal qualities of doctors when they choose specialities. The dearth of reports about paediatricians with poor communication styles, the authors say, might suggest that people with a calm and friendly nature are attracted more to working with children. This is contrast, the researchers claim, to the stereotype of surgeons as ‘Type A’ characters who tend to focus more on surgical precision than interpersonal exchanges3.
Making a diagnosis
Poor working relationships don’t just affect patient outcomes. Research shows an association between unprofessional behaviour and the well-being of the healthcare provider4. The Vanderbilt investigation describes how using the CORS report, allowed them to identify a pattern of unprofessionalism in individuals and in medical disciplines.
The granularity of these reports shows that different cultures exist within specialities and that a one – size-fits-all approach to training in bedside manner and communication won’t succeed. The authors hope that recognizing problem areas can help organizations to support staff better and to provide better guidance.
If investigations note a documented cadence of unprofessionalism within a speciality or organization, it might be necessary to take a closer look at the organizational culture and its leadership. When these patterns are caught early, hospitals can reduce cases of malpractice, patient complications, and lawsuits4.
The Right Prescription?
Above all, it is worth noting that more than 90% of the doctors in the study did not receive a single report about unprofessional behaviour. If this reflects the situation in most healthcare facilities, it is encouraging. The authors of the study acknowledge, however, some of its limitations. Examples they give point out that some clinicians avoid making a report about a colleague for fear of retaliation. The reports were not investigated further to see whether complaints were upheld. The classification of the conduct was based on credential files, which might not accurately align with what the physician actually does at the healthcare facility.
References
1.Cooper WO, Hickson GB, Dmochowski RR, et al. Physician Specialty Differences in Unprofessional Behaviors Observed and Reported by Coworkers. JAMA Netw Open. 2024;7(6):e2415331. doi:10.1001/jamanetworkopen.2024.15331
2.Khawar A, Frederiks F, Nasori M, et al. What are the characteristics of excellent physicians and residents in the clinical workplace? A systematic review. BMJ Open. 2022;12(9):e065333. doi:10.1136/bmjopen-2022-065333
3. Wainwright D, Harris M, Wainwright E. Trainee doctors’ perceptions of the surgeon stereotype and its impact on professional identification: a qualitative study. BMC Medical Education. 2022;22(1):702. doi:10.1186/s12909-022-03765-1
4. Trockel J, Bohman B, Wang H, Cooper W, Welle D, Shanafelt TD. Assessment of the Relationship Between an Adverse Impact of Work on Physicians’ Personal Relationships and Unsolicited Patient Complaints. Mayo Clin Proc. 2022 Sep;97(9):1680–1691. doi: 10.1016/j.mayocp.2022.03.005. PMID: 36058580.