While disruptive behavior is rooted in personality traits and often cemented by dysfunctional childhood experiences, Rosenstein and others say the brutal way in which doctors have been trained plays a role.
Traditionally, “medical students were told, ‘You don’t know anything, so shut up until you do,’ “ Rosenstein said. Many, he said, emerge from training as “autocratic, independent and dominant,” and they imitate the ways they were taught. “It’s a setup for disaster.”
Swiggart said that the three-day program at Vanderbilt, which is followed by three follow-up sessions over six months, focuses on developing and practicing coping and communication skills. Sessions are held about six times per year and are limited to six physicians, who must role-play the incident that brought them to Nashville.
“You need a group, and [participants] need feedback,” Swiggart said.
Few studies assessing the effectiveness of such programs exist. A preliminary study of 100 doctors who completed the Vanderbilt course showed statistically significant reductions in disruptive behavior as rated by co-workers, administrators and the doctors themselves. But Swiggart added, “Not everybody makes it. There are some individuals who really need to leave.”
The surgeon who fractured the tech’s finger described it as an accident fueled by sleep deprivation and a crushing workload. His hand, she said, was “where it shouldn’t have been” — on the patient’s metal leg strap.
“I was completely distraught that I had it in me to do that,” said the surgeon, who spoke on the condition that neither her name nor the Midwestern state where she practices be published. The hospital recommended she go to Vanderbilt at her own expense; about 20 percent of enrollees are women.
Although there had been no other overt incidents, she said that her career had been marked by “difficult interactions,” especially with nurses. “I felt hated,” she said, adding that she thought some were jealous of her. She did not cultivate relationships with co-workers and later learned that others avoided her because of what they regarded as a harsh style and chronic bad mood.