A recent Washington Post/Kaiser Health News story about anger management led with an anecdote about a surgeon who broke a scrub tech's finger by slamming down an improperly loaded instrument. The surgeon was suspended for two weeks and had to take an anger management course, which seems like a mighty small penalty for what could be described as assault.

But the story had to go where many such tales seem to go these days.

Here's a quote: "Experts estimate that 3 to 5 percent of physicians engage in such behavior, berating nurses who call them in the middle of the night about a patient, flinging scalpels at trainees who aren't moving fast enough, demeaning co-workers they consider incompetent or cutting off patients who ask a lot of questions."

Demeaning co-workers and berating nurses who call in the middle of the night? Yes, these things unfortunately do occur. But "flinging scalpels at trainees"? Sorry, I don't think so. But of course, exaggeration is a common feature of articles about doctors, especially if the story wants to portray us in a negative way.

I was a surgical chairman for many years. I know all about disruptive doctors. In a recent post, I even admitted to throwing an instrument myself once when I was a young and headstrong resident.

A link in the Washington Post story goes to a full text paper on disruptive behavior in the Journal of Medical Regulation (who knew there was such a journal?). The author points out that isolated episodes of what some might consider bad behavior can happen, but unless there is a pattern or the incident was egregious, doctors should not be labeled as disruptive.

There are many problems with disciplining disruptive physicians. The article addressed a few of them. 

Here are a couple that weren't mentioned. 

The disruptive doctor may be a busy surgeon or big admitter of patients. This puts the hospital in a bind, especially if there are other hospitals nearby. The doctor can and will threaten to take his patients across town. 

Or the bad actor may be the only physician in a critically important specialty on staff. 

These situations give physician miscreants leverage which tends to mitigate the punishment meted out—analogous to the way pampered athletes and movie stars are treated when they commit crimes.

I have first-hand experience with this having dealt with disruptive surgeons in the past. What I wanted to do and what the hospital administration would permit me to do weren't always the same. By the way, behavior modification programs rarely result in permanent cures. A middle-aged surgical ogre is not likely to become Prince Charming after two weeks of anger management.

So the issue is not as straightforward as it seems. 

By the way, just to show how far toward equality we have come, that surgeon who broke the scrub tech's finger was a woman.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 900 page views per day, and he has over 6100 followers on Twitter.