What do you do when a physician colleague, a 45-year-old surgeon and, until now, an outstanding, skilled, and professional member of the staff, has received several patient complaints over the past six months, has had a troubling uptick in complications, and recently has been verbally abusive to the nursing staff?
Explore this issue:April 2019
This scenario was part of a session at the Triological Combined Sections Meeting featuring a panel of leaders in otolaryngology and a lively discussion with audience members on the slippage in professionalism occurring in the medical field, and how to confront the problem. Panelists and others emphasized the need for vigilance and speedy and sensitive intervention to keep problems from spiraling, and decisive action when the need arises.
In the case of the 45-year-old surgeon with recent problems, Jonas Johnson, MD, chair of otolaryngology at the University of Pittsburgh, suggested thinking of the surgeon as having a disability. “We have disabled surgeons in our environment. You might think of disability as something that happens when you’re older or at the end of your career, but surgeons become disabled for a variety of reasons mid-career,” he said. “This to me looks like somebody who’s become disabled.” He could be struggling with addiction, or even an early stage of dementia, he added.
Stanley Shapshay, MD, professor of otolaryngology at Albany Medical College in Albany, NY, said that some physicians deal with stress in troubling ways. “It’s a wonderful career, but it’s stressful. And how do we deal with stress? And I think maybe that’s part of this surgeon’s issue,” he said. “This is a stressful situation, and we need to talk to this individual and find out what’s going on.”
The first intervention’s usually a cup of coffee; you send in one of your peers to talk [to the colleague]. —Amelia Drake, MD
The word “professionalism,” while it’s bandied about frequently, has a definition that can be hard to pin down.
Gerald Healy, MD, emeritus chair of otolaryngology at Boston Children’s Hospital and moderator of the session, said professionalism is a complex blend of many attributes: a neat appearance, a demeanor that exudes confidence without cockiness, reliability, competence, ethics, poise, proper phone etiquette, and appropriate style of written correspondence.
A degrading of professionalism isn’t just some vague concern, he said. It involves a loss of basic skills that can affect patient care, resulting in a physician who spends less time with patients and experiences less joy in the practice of medicine. Technology and the structures of health systems are contributing to the slide in professionalism, he said.
Overuse or misuse of social media is chipping away at professionalism, he added. “It’s unfettered information that can lead to depressing thoughts, depressing problems, et cetera. Unhappiness. People complaining all the time, [worsening] relationships,” he said. “We need to think about this issue. It’s real.”
Burnout, he said, is born of emotional exhaustion, long-term job stress, a sense of being overwhelmed, and a loss of personal accomplishment. “Those are all things we hear in the locker room,” Dr. Healy said. “What are we doing about it?”
Physician suicide has been receiving more attention recently, he noted. While otolaryngology has the lowest suicide rate among medical specialties, ear, nose, and throat physicians should still watch out for people who might need help. Otolaryngologists should “be vigilant of doctors, our colleagues in other specialty areas, that we might recognize as having issues that we need to help.”
Dr. Johnson said that sometimes dramatic action, such as pulling clinical privileges, must be taken quickly when a physician is being abusive or incompetent. “My experience has been that overwhelmingly these individuals say there’s nothing wrong. And they want to just move straight forward. So you have to stop them,” he said.
Dr. Healy said it was important to remember that revoking clinical privileges is a “large, consequential event,” likely involving notification of state regulators and the specialty’s certifying board.
But more modest steps can sometimes be appropriate. Amelia Drake, MD, professor of otolaryngology-head and neck surgery at the University of North Carolina-Chapel Hill, pointed to Vanderbilt University’s Patient Advocacy Reporting System (PARS) and Co-worker Observation Reporting System (CORS) as a program that uses a softer approach when possible. “The first intervention’s usually a cup of coffee; you send in one of your peers to talk [to the colleague],” she said.
“Listening is the important thing, not so much talking,” Dr. Shapshay said. “I think you could probably get the diagnosis just as you would by taking a medical history. The differential diagnosis in this case would include impairment from substance abuse as well as organic causes such as dementia and brain tumor.”
Thomas R. Collins is a freelance medical writer based in Florida.