Approximately 5% of practicing physicians in Canada engage in recurrent disruptive behaviour - inappropriate words, abusive language, shaming, outbursts of anger or threats of physical force, refusing to work cooperatively with others or being chronically late for scheduled patient appointments or meetings; or paying more attention to email than to discussions during work-related meetings.

Said : the Canadian Medical Protective Association (CMPA) located at Ottawa - Canada's capital and the fourth largest city in the country - in its discussion paper titled "The role of physician leaders in addressing physician disruptive behavior in healthcare institutions," released during its 2013 annual meeting held on August 21 this year. The paper addresses the issue of disruptive behavior and recognizes the negative impact of this behavior on providers and on patient safety. The Association has more than 86,000 members. (download full paper in pdf here) According to the discussion paper, although all health professionals, including administrators, can demonstrate disruptive behavior it may be particularly noticeable among doctors due to their role in the provision of care. Studies show approximately 5% of practicing physicians engage in recurrent disruptive behavior  These physicians are at risk of medico-legal consequences including human rights complaints and hospital investigations which can lead to suspension of hospital privileges. As well, investigations by Colleges can lead to suspension, restriction, or revocation of medical licensure, and termination of a medical career.

The paper notes that nearly 73% of respondents to the Canadian Association of Internes and Residents 2012 National Resident Survey reported experiencing inappropriate behavior by others that made them feel diminished during their residency. Half of all respondents (50.5%) experienced this behavior from other staff physicians or nursing staff. The most commonly cited behavior was yelling, shaming, and condescension (the attitude or behavior of people who believe they are more intelligent or better than other people). All physicians can experience or witness disruptive behaviour at some point in their careers.

Dr. John Gray

According to Dr. John Gray, CEO of the CMPA, there is interest in the healthcare community to address the issue of disruptive behavior  While this is in part due to regulatory and legislative changes, the growing sentiment in the healthcare community is that disruptive actions by doctors and other providers have never been acceptable, and collectively, the community needs to eliminate this conduct. “Disruptive behavior is a complex issue,” added Dr. Gray.  “It involves identifying the behavior and assessing whether any underlying factors exist that may be contributing to these actions, such as excessive workload, stresses in the work environment or individual physician health issues. While physician leaders play an essential role in this process, disruptive behavior requires a collaborative and tiered response.” “Every effort should be made to address disruptive behavior  when it happens,” said Dr. Gray. “Early identification and proactive intervention combined with a thorough workplace assessment and remediation when necessary, can yield positive results. Given the challenges with Canada’s physician supply, every effort should be made to retain high performing physicians.” 

The CMPA concludes that continued collaboration and dialogue at the national, provincial, territorial and local level are necessary to help mitigate and eliminate disruptive behaviour in the healthcare environment. The CMPA will continue to work with physician leaders, institutions and stakeholders to advance this important discussion. (Source : CMPA)