Addressing Unprofessional Behaviour Among Physicians

It’s not a topic anyone likes to discuss publicly – which is one of the reasons incivility, bullying and other forms of unprofessional behavior by physicians to physicians has persisted. To help turn the tide, University of Toronto researcher Sharon Straus and colleagues recently reviewed the scope of the problem and combed the scientific literature for possible solutions.

How common is incivility among physicians?

The evidence shows when students and residents are in training, 60 percent of people experience at least one incident of harassment. When physicians are surveyed, up to 98 percent have experienced unprofessional behaviour. Most commonly, it comes from patients or their families. But it’s also perpetrated by co-workers and supervisors. It is unfortunately not an uncommon issue and has an impact on individuals.

What is the impact on medical students and residents?

When you experience unprofessional behaviour, it can lead to anxiety and depression and impacts workplace retention. Ultimately it can impact patient care, as people are under stress. In an academic centre we have to worry about the role modeling that happens for trainees. When they witness or experience this, how does that impact their behavior by seeing this behavior go unchecked? This is what we call the ‘hidden curriculum.’

What are some ways to address this behavior?

We did a literature review, and found 23 articles that were eligible for inclusion in our paper. Strategies mostly focused on targeting clinicians – generally by increasing awareness of unprofessional behaviour. But we know education is not sufficient to change behavior. There wasn’t a lot of specific work on how we address the behavior, particularly in ways that would lead to change. For example, only four studies targeted the organization. We have to address this behavior on an institutional level – like making sure we have explicit transparent processes for victims of these behaviors to come forward. And institutions need clear timelines for addressing these issues, and support for remediation and rehabilitation for both the perpetrator and victim.

Another institutional change is tying professionalism to awards and promotions. In the Department of Medicine over last 18 months, we have made it a requirement that people have to have demonstrated professionalism to go forward for promotion or to pass their continuing faculty appointment review. This is critical. We also know from literature that if people are behaving unprofessionally and this is a new pattern, we have to ask why the change. It’s a physician wellness issue.

Have you experienced unprofessional behaviour in your career?

When I was thinking of applying for geriatrics, I remember being told what a waste, why would I ever want to do that? Even as a trainee, I was being denigrated for choosing geriatric medicine. That’s probably one of the more gentle examples. Many of us have experienced comments because we’re women, like interviewing for a new job and right away being asked our age, marriage and family plans because of worries about how these might impact our job productivity.

Do you think unprofessional behaviour is getting better or worse?

That 60 per cent figure for trainees has been constant over many years. But I do agree people now are feeling more comfortable coming forward and talking about it. The MeToo movement really highlighted how important it is to look at this, and how important this is to physician wellness and ultimately patient care.

It sounds like there’s reason for optimism.

Yes, over the last two years we’ve really been working to establish explicit and transparent processes in the hospitals and at the university, although we can always do a better job making clear what those processes are. And that there’s good communication between the hospitals and university.