This isn’t your doctor

Recently, I reported on the rise of a dangerous, new hospital-acquired infection. Today, I will report on another “infection” growing in hospitals across the country–unethical physician behavior.

A recent study published in the Journal of Hospital Medicine uncovered a startling amount of unprofessional behavior among physicians working in three Chicago hospitals. The researchers surveyed 77 hospital-based physicians–known as “hospitalists.”

These doctors typically do not have a private practice. Nor do they have their own patients. They work exclusively for the hospitals. In addition, hospitals can hire these physicians directly out of residency. So they lack any real-world experience outside of a hospital setting. And apparently, they never took a medical ethics class either. Or else, they slept through it.

The behaviors these hospitalists admitted to are inexcusable…

Two-thirds of hospitalists surveyed admitted to having personal conversations, such as discussing evening plans, in front of patients. Two-thirds of the doctors also said they lied about a routine test being “urgent.” Just to get it done faster for their convenience. This practice sounds benign enough. But it clutters up emergency laboratories. And potentially delays true emergencies.

Nearly half the doctors said they mocked other physicians to colleagues. And about the same number said they bad-mouthed ER doctors for missing a patient’s medical problems. Perhaps the ER docs missed these problems because they could not get their own, truly urgent tests done more quickly!

In addition, one-third of the doctors said they made fun of patients while on rounds with other colleagues. Nearly as many said they attended dinners or social events sponsored by drug companies, medical device manufacturers, or other businesses. These companies often stand to benefit from the doctors’ decisions.

The hospitalists also admitted to dumping work on someone else. According to the study, about one out of 10 physicians said they transferred patients to another doctor to reduce his or her own workload. They admitted they could have continued to provide the care themselves. Instead, they jeopardized the patients’ “continuity of care” to make unjustified switches.

Hospitalists call this practice “turfing”–as in getting a patient “off your own turf.” And it’s a common strategy used to lighten workload. In fact, more than one out of 10 physicians admitted they went out of their way to even “celebrate” a successful turf.

And a similar proportion of doctors said they “blocked” a patient. In other words, they refused to accept a patient into their unit by claiming another part of the hospital should care for the patient. And nearly twice as many hospitalists “celebrated” a blocked admission to their unit.

The study authors said truly “egregious” behavior–as compared to merely “unethical,” I suppose–was rare.

So–what “egregious” behaviors did they consider so rare?

For one, only 7 percent of doctors admitted to falsifying patient records. This kind of crime can kill a patient. And land the doctor in criminal court. But don’t worry–say the study’s authors–only 7 percent of doctors admitted to this.

And just 3 percent of doctors admitted to performing medical or surgical procedures beyond their skill level. Again–this kind of behavior can kill patients. And land the doctor in court.

Now, remember. These statistics are based upon what the doctors actually admitted about themselves. But are they accurate?

The real statistics are probably much higher.

In fact, the same group of hospitalists reported seeing another doctor act unprofessionally much more frequently than they admitted doing so themselves.

So what are the real numbers?

More than two-thirds of doctors said they witnessed another doctor “blocking” a patient. This is eight times as many who admitted blocking patients themselves.

And nearly 20 percent of the doctors said they observed another doctor discharge a patient before they were ready to go home. Yet, less than 3 percent of doctors admitted to doing this themselves.

One of the authors of the study said, “The goal is to figure out what types of behaviors people are not in touch with, that come across as unprofessional.”

That was the goal of the study? To figure out what “comes across as unprofessional”?

When I went to medical school, they had long ago “figured out” that everything on that list not only “comes across as unprofessional,” but also is unethical. And, in some cases, illegal to boot. In fact, if you couldn’t figure that out on your own, you probably should never have been admitted to medical school in the first place.

The study author acknowledges that the survey has its limitations. And that doctors may not admit to bad behavior. Even in an anonymous survey.

However, she said, the study focused on unprofessional actions the doctors did admit to doing themselves. Because those actions are more persuasive to hospital officials who put together trainings on professionalism for doctors and residents.

This sounds more like topics for a parole board hearing than professional review board or training.

And I’m afraid the trend toward unprofessionalism will continue to plague hospitals. This is because too many “hospitalist” doctors work exclusively at hospitals today. They have no real world, private practice experience.

It used to be that your own private physician admitted you to the hospital. And he or she helped look after you there.

But now it’s “hands off.”

And you get care from some guy or gal who doesn’t know you. And has probably never seen you before. And will probably never see you again. So much for “continuity of care” that the Affordable Healthcare Act is so concerned about.

Part of the disintegration of medicine comes from the hospitals’ bright idea to create hospitalists.

When doctors go straight to work for hospitals, it’s as if they never finish their internship and residency. They never get out of that stifling, artificial, and toxic world of the hospital. And they never go out into the real world to see patients. Real men and women who live and work in their communities.

Instead, this “hospitalist” approach is like a perpetual medical adolescence. And it seems to perpetuate adolescent behavior as well. It seems many of these hospitalists never really grow up and develop the conscience required of a mature, trusted and wise physician.

So perhaps it is not surprising that this new study found them behaving like adolescents as well–in unprofessional ways more fitting for a first-year medical student. Entrusted with nothing more than a cadaver, when it comes to human medicine.

Back in my day, though, first-year med students with immature and unethical behavior never made it past their first-year cadavers. But now, the hospitals are breeding them, together with the “Superbugs” I told you about previously.

Source:

1. J Hosp Med. 2012 Sep;7(7):543-50. doi: 10.1002/jhm.1946. Epub 2012 May 16.

 

 


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