SDS Accreditation Update

Why does surgery setting lead to more outbursts?

Consider these contributions, strategies

Surgeons are disproportionately represented in attendance at a course on disruptive behaviors offered by the Center for Professional Health at Vanderbilt University in Nashville, TN. Also, many anesthesiologists attend. Is there something about the surgery setting that can cause disruptive behavior? Or do these medical specialties attract personalities who are more prone to outbursts?

"I think that there are situations where they are expected in be in charge of a lot of people that they aren't necessarily in charge of or can control," says William H. Swiggart, MS, LPC/MHSP, co-director of the Center for Professional Health. The center offers one of the most extensive programs in the nation to track and address poor staff behavior. "If something goes wrong, they're the captain of the ship; they're responsible," he says.

Sometimes physicians and others who are prone to outbursts will use the reason, "I'm doing this for patient care. I have to do this because I'm responsible for the patient," Swiggart says. "That can't be an excuse for abominable behavior," he adds.

Some staff members are lacking in people skills, Swiggart says. "To get someone to perform better, they may scream or throw something at them," he says. "That might have worked for their mentors, the people who trained them, but in this day and time, it doesn't slide."

The Center for Professional Health, among other activities, offers continuing education on maintaining proper boundaries. Vanderbilt began focusing on staff outbursts 10 years ago when administrators found that physician lawsuits often were related to patient complaints.1

'They're issues for everyone'

It's important to keep in mind, however, that nonprofessional behavior isn't solely a physician issue, says Gregg Meyer, MD, MSC, senior vice president of quality and safety at Massachusetts General Physicians Organization and Massachusetts General Hospital, both in Boston. "They're issues for everyone across the organization," he says.

Managers might have to address immature, offensive staff; staff who bully new staff, or other managers who belittle subordinates or ignore residents. When staff members are having repeated behavior issues, sit down with the persons individually, talk about their issues, and do problem solving to determine what you can do to resolve the issues, Swiggart advises. "Sometimes the system is creating problems," he says. For example, surgeons often complain "my cart is never right. I never get the instruments I'm supposed to."

"I tell them, 'Maybe you need to fill your own cart. Or maybe you need to talk to them 10 minutes ahead of time to say: It's important that you get my cart filled correctly,'" Swiggart says. "Systems issues don't respond well to being yelled at."

A surgeon prone to outbursts might complain that if a staff person is late with a chart at 8 a.m., it puts them behind 15 minutes and, by the end of the day, they are two hours behind. "They explode because someone doesn't bring a chart on time, but they can see the whole day crumble," Swiggart says. "They have a hard time adjusting midflight."

Encourage time to relax

Encouraging an atmosphere in which it's acceptable to relax for a few minutes can be helpful, he says. Also, a time out or a briefing before starting a procedure can be useful, Swiggart says. In a briefing, everyone on staff typically introduces themselves, and the staff discuss the surgery they are about to perform. "The briefing is a way of saying, 'We're in this together; I need your help.' And they get some support before they go in."


  1. Kowalczyk L. Hospitals try to calm doctors' outbursts — Medical road rage affecting patient safety, group says. The Boston Globe, Aug. 10, 2008. Accessed at


The Center for Professional Health at Vanderbilt Medical Center offers three CME courses, including the Program for Distressed Physicians. The three-day course includes three follow-up days over the next six months. The cost of the course is $4,000. The web site also has links to articles on the topic. For more information, contact: