“In nothing do men more nearly approach the gods than in giving health to men.” ― Cicero
That kind of exaltation from one of history’s greatest statesmen is heady stuff. But it also sets an impossibly high standard for physicians. Doctors are not reaching for godliness. Sometimes they, like anyone else, fall short of their own and society’s standards of behavior.
Medscape’s “Physicians Behaving Badly: Stress and Hardship Trigger Misconduct” reported on survey responses from more than 1500 physicians. Doctors were asked how often they saw fellow physicians misbehave in person (either at or away from work) or on social media, among other questions.
Some commenters felt such a survey by its nature places medicine in a bad light, even though incidents of physician misconduct were relatively uncommon. “Shame on you, more than 1500 physicians, who facilitated this attack on our profession,” wrote one irate doctor.
But other commenters and survey respondents felt the spotlight on physician conduct is helpful. “Thanks for gathering information on this grossly understudied topic,” one psychiatrist respondent wrote.
There Will Always Be “Bad Apples”
Poor behavior often is judged on the basis of society’s general standards and expectations. The majority of respondents felt these standards and expectations for physician behavior, both at and away from work, are at appropriate levels. But 38% said standards for how they act away from work are too high. “Doctors are human too!” was a frequent reminder.
One neurologist respondent echoed this idea. “Physicians are different people with different personalities, and they run the gamut from boring to disinhibited. These problems have been there for centuries. There have always been very professional and very unprofessional physicians throughout history.”
More than half of respondents felt general personal arrogance and/or personal problems that are unrelated to work play a role in inappropriate doctor behavior.
“I think arrogance makes these physicians think they can do whatever they want without repercussions,” a pathologist respondent argued.
A commenter added, “In my experience, more often than not, bad physician behavior is caused by cussedness, plain and simple, among doctors who are either arrogant or insecure or both. There’s no way to keep a few bad apples out of the barrel. As the old ones drop out, new ones slide in.”
The Impact of Relentless Stress
Many doctors believe you can’t overstate the effects of job-related stress, which became worse during the COVD-19 pandemic and still worse in the healthcare labor shortage that followed.
“Most people, even doctors, will tend to ‘behave badly’ when they are overworked, underpaid, underappreciated, and ignored when they speak. That is human nature,” one commenter observed.
“COVID put us into a whole different galaxy, with hospitals and insurances trying to squeeze every penny. It is beyond what most can handle,” a pediatrician respondent chimed in.
Physicians pointed out that rude or aggressive behavior by patients is increasing, too. Increased access to doctors through patient portals and telehealth means “there is pressure to be available 24/7,” an internist respondent wrote. “When doctors have no personal time, they become irritable and resentful…so they lash out at staff.”
Changing Times, Changing Mores
Behavior that one physician sees as inappropriate and/or unprofessional might be viewed as perfectly normal by another doctor. Half of survey respondents felt changing times and acceptance of more casual behavior are important influences.
“Societal mores have changed significantly, allowing for a more relaxed sense of self in terms of how one presents themselves as a physician,” observed one respondent, a family medicine physician.
Not surprisingly, age shapes views of what is inappropriate behavior. For example, 82% of boomer-age survey respondents think it’s unacceptable for doctors to post photos of themselves wearing revealing swimwear or drinking alcohol; but only 39% of millennials agree.
“There are generational issues between ‘old guard’ and younger physicians in their definitions of professionalism,” one respondent noted. An internist respondent put it more directly: “Wearing a bikini is not ‘unprofessional behavior.’ It’s called living a life and being on vacation.”
How much are social media shaping what is acceptable or unacceptable? “Lines between personal and professional lives are completely blurred,” a surgeon respondent said. “The anonymity allowed on social media, as well as the typical negative commentary, encourages misbehavior.” But another respondent argued that social media simply make public unprofessional behaviors that have gone on for decades.
Doctors were more in lockstep about their colleagues using social media to promulgate misinformation, especially regarding COVID. “Physicians should know better than to be publicly speaking out against validated health measures and failing to support public health guidelines,” one respondent complained.
The Effects of Polarization
Physicians do not seem to be above political silos that plague the rest of American society, commenters and respondents lamented. “As a nation, we have become polarized and this has spilled over into the medical field,” a pediatrician respondent said. “It is becoming more acceptable to belittle those who do not share the same politics…. I have seen it in the hospital setting, in meetings, and in public,” a family physician added.
“I witnessed multiple physician providers attack each other on social media over politics, COVID quarantines, and vaccines,” an emergency medicine physician respondent wrote.
“The world’s gone bananas these past two years,” a public health specialist said. “Physicians are not exempt from the stupidity and craziness.”
What Should or Can Be Done?
Rather than accept physician misbehavior as normal or inevitable, one commenter argued, the medical profession needs “system-wide revisions” of working hours and a real emphasis on improving work-life balance.
Other doctors saw a need for physician-specific training on appropriate use of social media and on sensitivity of language in person and online. “Technology changes fast, and some individuals have not had time to catch up with that reality,” a urologist respondent said.
Batya Swift Yasgur MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).
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