Bad behavior by physicians to be confronted
Bad behavior by physicians to be confronted
Fear of retaliation stops some from reporting it
Editor's note: In the August 2008 issue, Medical Ethics Advisor reported on a new requirement by The Joint Commission to become effective January 2009 that hospitals monitor and correct so-called "disruptive behaviors" by health care professionals at their institutions. This month, MEA spoke with Laurie Zoloth at Northwestern University's Center for Bioethics, Science and Society. To discuss how physicians should address either incompetent or other bad behavior by other physicians.
Whether it's disruptive behavior or bad treatment of a patient due to incompetence, physicians and their colleagues can's simply choose to look the other way, according to ethicist Laurie Zoloth, PhD, professor of medical humanities and bioethics at Northwestern University's Feinberg School of Medicine. She also is director of the Center for Bioethics, Science and Society at Northwestern's Feinberg School.
But rather than scurrying off to file an anonymous or other type of complaint against a colleague behaving badly for whatever reason, the best approach is the direct approach.
"I think they're legally bound to confront their colleague, and I think that's true in every setting," Zoloth tells Medical Ethics Advisor. "It's extremely difficult in societies like ours that value collegiality and being nice . . . ."
The issue of bad behavior – again, whether it fits the definition of The Joint Commission's "disruptive behavior" or the prescribing of the wrong medication or wrong treatment for a patient – can become very personal when colleagues are forced to look at themselves, and decide their own reaction.
For example, Zoloth says, this is a type of situation that occurs often, and it is up to that individual to decide whether to "intervene to stop it and reclaim it from the insanity in the universe."
As with the illustration of surgeons/physicians and dealing with patients under sedation, in this situation, as well, Zoloth maintains that "all behavior is witnessed behavior."
"I think in every single area, you have to tell someone when they're doing something wrong," Zoloth says. "And I think that sometimes . . . the only excuse for not doing it is if you think they're going to hurt you."
Even if a colleague's response doesn't reach the level of outright aggression or violence, there are ways that they can retaliate professionally.
Confronting bad behavior, she says, is a "terribly important lesson."
"When you hear people say, 'I couldn't say anything, I was afraid he would retaliate, then you know something is broken far more than the individual person — you know, there's a brokenness in the system that doesn't allow people to confront wrongdoing," she says.
Fear of retaliation in reporting wrongdoing can certainly be a fear in medical students, interns, or residents.
She suggests that for those at this level of the health care profession, a "mechanism needs to be found for those complaints and those observations to be made without the individual person's career being devastated. And that's a very fine line."
Another component to such a situation is the "right of the accused to confront [his/her] accuser," she says, which opens up an entirely different level of "complexities."
"If you can have it as a practice that if you do bad behavior, then it's not going to be tolerated because your peers are going to stop it, that's the ideal before you get into hierarchical relationships and action and reporting."
Editor's note: In the August 2008 issue, Medical Ethics Advisor reported on a new requirement by The Joint Commission to become effective January 2009 that hospitals monitor and correct so-called "disruptive behaviors" by health care professionals at their institutions. This month, MEA spoke with Laurie Zoloth at Northwestern University's Center for Bioethics, Science and Society. To discuss how physicians should address either incompetent or other bad behavior by other physicians.Subscribe Now for Access
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