In the current issue of Psychotherapy
and Psychosomatics a topic that is seldom discussed in medical journals is analysed.
Current health care requires effective collaboration among providers. Poor
communication may lead to poor patient outcomes. Although emphasis has been
placed on interprofessional communication (particularly between physicians and
nurses) in the health system, little has been written about problems in
communication within the medical profession.
Who Are the Difficult Colleagues? There is not a single,
unifying term or definition delineating difficult, impaired, disruptive, or
problem doctors. These doctors are usually described as physicians who are
unable to perform their professional duties, often due to issues including
mental or physical illness, or whose intimidating and disruptive behaviours,
including overt actions such as verbal outbursts and physical threats,
compromise the care and well-being of their patients.
In this article Dr Jose de Leon of the Mental Health
Research Centre at Eastern State Hospital in Kentucky in the US and colleagues
highlight that communication difficulties occur from stable patterns of
negative behaviour on the part of physicians, which psychiatrists call
personality disorders, and/or situational issues related to trust, clinical
judgment, and interactions with consultants.
According to the authors, doctors can recognise “difficult
colleagues” but they do not write about them because their traditional code of
ethics encourages respecting other physicians as if they are family members,
and because the pattern of medical education follows what is called “tacit
learning” from a physician mentor but does not include questioning how doctors think.
However, reporting “impaired doctors” with obvious psychosis or signs of
addiction is a straightforward, clear-cut responsibility for their colleagues.
Addressing problems that result in difficult communications
between physicians requires interventions at different yet integrated levels
starting with medical education, dealing with situational issues, and dealing
with physicians with personality disturbances. For example, formal medical
education concerning interpersonal communication, professionalism, disruptive behaviour
and dealing with disruptive or difficult physicians is crucial in dealing with
the outlined issues and hopefully preventing them.
The authors concluded suggesting that special attention
should be devoted to “problematic institutions”. Indeed, few physicians
practice in isolation or small medical groups; most work in institutions, such
as academic centres, hospitals or outpatient organisations. This increases the
possibility that communication problems may not be associated with a problematic
physician but with a problematic institution that tries to control or force
physicians to do things the physician finds unethical or inappropriate.
Moreover, problematic institutions may empower problematic physicians to reach
positions of power, making the institution progressively more abnormal.
Leon J, et al. Dealing with Difficult Medical Colleagues. Psychother Psychosom
2018;87:5-11. Published 19 February 2018. https://www.karger.com/Article/FullText/481200