The Dark Underbelly of Medicine

The medical culture is taking it on the chin. Doctors are being accused of racism, sexism and student and trainee abuse as the veil of secrecy has been pulled back revealing “the dark underbelly.”

Every doctor has been subjected to or witnessed unprofessional behavior. A few have perpetrated it. Now, for many reasons, clinical leaders are forced to deal with it. The issues and challenges are widespread:

1. How big of a problem is it?

2. How do you separate behavior that is clinically disruptive from that which is organizationally “disruptive” in the business sense?

3. What are the root causes and drivers of unprofessional behavior?

4. Have the definitions changed over the years in response to societal demands? The American Medical Association describes “disruptive conduct” as personal conduct, whether verbal or physical, that affects or that potentially may affect patient care negatively. Do we need to change the definition? If we do, what impact would that have?

5. What factors perpetuate the “white wall of silence”?

6. How does disruptive behavior impact patient safety and quality of care?

7. Why is it just now receiving the attention it is getting?

8. How should we monitor, report, and deal with doctors who are found to be “disruptive” and what should “physician due process” look like given the repercussions of an adverse finding?

9. Should disruptive doctors be punished, rehabilitated, or both and how?

10. Should disruptive physicians be publically exposed?

The "something rotten" in the state of medicine is stinking and the medical profession needs to be more proactive in containing the stench. It is not just coming from one bad apple.