Mass Hospitals Crack Down on Doctors' Abuse

It may not have occurred to the WSJ Health Blog that surgeons throw instruments in fits of pique, but this type of behavior is nothing new to those in healthcare. Finding a medical trainee who's observed verbal or threatened physical abuse from surgeons in the OR is the act of finding a medical trainee.

For the young and relatively uninitiated, the tolerance of bad behavior from medical superiors toward nurses and other healthcare workers has been taken as a matter of course in the stiffly hierarchal world of medicine. And in some cases, the tolerance of abuse serves as a license for trainees to mirror the behavior. But this misguided tolerance is finally waning, and rightly so—even if it means losing the lucrative business of surgical specialists.

The Boston Globe reported Monday that Massachusetts hospitals, like the North Shore Medical Center and Saint Vincent Hospital, are adopting a kind of 3-strikes rule for physician outbursts, before some kind of discipline is implemented. Of course, intervention after 1 or 2 strikes should be considered by any hospital administration, depending on the behavior.

Another deterrent is to publicize the names of those who exhibit the alleged bad behavior: like orthopedic surgeon Peter J. Mulhern, who reportedly threw 2, 10-pound limb-stabilizing sand bags in the Saint Vincent OR, hitting a nurse's foot; or orthopedic surgeon Murray J. Goodman, who reportedly flung dull scissors in the North Shore OR, just missing a nurse's head.

While doctors' bad behavior may be explained (or excused) by the high-stress environment in the OR and the fact that "[s]urgeons hold patients' lives in their hands," the sand-bag incident with Mulhern occurred in the context of 2 delayed surgeries for carpal tunnel syndrome, wrote The Globe—hardly a life-in-the-balance condition.

The Globe also reported that Mulhern was suspended by Saint Vincent in 2002 and moved his practice to Fort Oglethorpe, Georgia.* Goodman is evidently still affiliated with the North Shore Medical Center in Massachusetts.

The Massachusetts hospitals' disciplinary actions are presumably in line with recommendations from the Joint Commission, which released an alert last month requiring that "all accredited hospitals create a code of conduct that defines acceptable and unacceptable behaviors and...establish a formal process for managing unacceptable behavior," beginning January 1, 2009.

* Which is sufficient punishment in my mind.

Photo of piece of surgeon's arsenal: iStockPhoto