Tuesday, October 30, 2012

Doctors Admit to Unprofessional Behavior in Study at 3 Chicago Hospitals

Working in a real hospital isn’t usually as dramatic as is portrayed in TV shows like Grey’s Anatomy orHouse, MD, but a new study has identified unprofessional behaviors to which hospital-based doctors most frequently admit, including badmouthing fellow doctors and finding medical excuses to get out of having to care for patients.
Two-thirds of doctors surveyed at three Chicago hospitals copped to having personal conversations, such as discussing evening plans, in earshot of patients, and 62 percent said they had mischaracterized a routine test as “urgent” to get it done faster. Four out of 10 said they mocked another physician to colleagues. The same number said they bad-mouthed emergency room doctors for missing part of a patient’s medical problems.
Three out of 10 said they made disparaging comments about a patient on rounds. Twenty-nine percent said they had attended a dinner or social event sponsored by a drug or medical device manufacturer or other business that stood to gain by a doctor’s decision.
The study, published in the Journal of Hospital Medicine, was based on the responses of 77 hospital-based doctors–known as hospitalists–from the University of Chicago Pritzker School of Medicine,Northwestern University Feinberg School of Medicine and NorthShore University HealthSystem.
Some of the unprofessional behaviors involved dumping work on someone else.  According to the study, 9  percent admitted that they had transferred a patient they could have taken care of to another in order to reduce their patient load. This practice is known as turfing, and 12 percent of physicians admitted they had “celebrated” a successful turf. Eight percent of doctors said they had blocked a patient, which means they refused to accept the patient into their unit by claiming the patient should be cared for in another part of the hospital. Twenty-one percent acknowledged celebrating a blocked admission.
The study noted that “participation in egregious behaviors, such as falsifying patient records (6.49%) and performing medical or surgical procedures on a patient beyond self-perceived level of skill (2.60%), was very low.” But more hospitalists reported seeing another doctor act unprofessionally than admitted they did so themselves. For instance, 68 percent said they had witnessed another doctor “blocking” a patient–eight times as many who admitted doing the blocking. And almost 20 percent of doctors said they had observed a patient being discharged before they were ready to go home, while only 2.6 percent admitted to doing that.
Dr.Vineet Arora, one of the authors of the study, said observations of unprofessional behavior can be wrong because doctors don’t “know the full context of the story” or because more than one doctor can report seeing the same incident, inflating the number. She said the study focused on rates of unprofessional actions that doctors admitted participating in, because those are more persuasive to the officials who put together trainings on professionalism for doctors and residents.
“The goal is to figure out what types of behaviors people are not in touch with, that come across as unprofessional,” she said. She said that since doctors may not admit to bad actions even in an anonymous survey, the real rates of some of the unprofessional actions may be somewhere between the number doctors admitted to doing and the number they claim they observed.
Commentary: I found this study fascinating in its definitions of possible "unethical behavior". It showed that most of us doctors are human too, and have our frailties and weaknesses. It also suggests that many a times we may be aware of the 'unethical' nature of our conduct, but may carry on regardless.
Looking at myself, I feel that I have probably done most of the above mentioned stuff at some point of my career, and continue doing some of this, specifically "attended a dinner or social event sponsored by a drug or medical device manufacturer or other business that stood to gain by a doctor’s decision" even now, along with most other private practitioners of our fraternity." I am not sure that I completely agree with this being unethical behavior though, since this is one of the more important ways to learn about new stuff in medicine, especially for doctors from non-academic background in India, and helps us network with other doctors too.

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