Preventive Medicine and the Seven Deadly Sins: Avoiding Discipline Against your
Each of these sins reminds me of some truly outlandish investigations, and anger
is no exception. Anger rages in a variety of styles. Some cases are predictable,
some are eccentric, and a few, with only the names changed to protect the innocent,
could be made into movies starring Anthony Hopkins and Jodie Foster.
Let me provide a few examples:
- A physician became angry with his accountant and hired a hit man to murder him.
At the time the undercover police officer consummated the deal, the physician had
a change of heart and decided he merely wanted the officer to break the accountant's
- A surgeon became infuriated with a scrub nurse and hurled blood on her during an
- Another surgeon graciously offered his services as an assistant during his wife's
operation. He sutured his wife's vagina completely closed.
- A physician under peer review investigation by a hospital surreptitiously (or so
he thought) wandered around the hospital parking lot keying the cars of hospital
- A surgeon purposely slashed his assistant's hand with a scalpel.
- An emergency room physician arrested for drunk driving told the officer that if
he showed up in the doctor's ER, the doctor would let him die.
- An attending surgeon grew impatient with a fledgling resident and began throwing
instruments in the operating room.
Most of the examples cited above also were criminal violations of law for which
the physician was convicted and sanctioned criminally. When physicians are arrested
and charged with a felony, or convicted of a felony, the Medical Board is notified.
The Medical Board then will investigate pursuant to Business and Professions Code
section 2236, which defines the conviction of a crime as "unprofessional conduct."
Specifically, section 2236 reads:
When a physician is convicted, an investigation customarily will involve obtaining
the criminal charging and conviction documents and police reports. We then will
invite the physician to attend an interview to provide their side of the event.
This information is assimilated into a package that then is forwarded to the Office
of the Attorney General where a determination is made whether administrative charges
should be filed.
What happens in the above-cited examples when a conviction does not accompany the
act that brought the physician to our attention? When it comes to anger, the board
has another mechanism by which to insure public safety: the mental/physical examination.
This happens frequently in cases where a physician is arrested, but not convicted,
for domestic violence. Often the victim of the abuse does not wish to cooperate
with law enforcement authorities. Business and Professions Code section 820, however,
allows for the board, when good cause exists, to compel a physician to be examined.
Section 820 reads: "Whenever it appears that any person holding a license, certificate
or permit under this division or under any initiative act referred to in this division
may be unable to practice his or her profession safely because the licentiate's
ability to practice is impaired due to mental illness, or physical illness affecting
competency, the licensing agency may order the licentiate to be examined by one
or more physicians or psychologists designated by the agency. The report of the
examiners shall be made available to the licentiate and may be received as direct
evidence in proceedings conducted pursuant to section 822.
"If the examiners conclude the licentiate's ability to practice his or her profession
safely is impaired because the licentiate is mentally ill, or physically ill affecting
competency, the licensing agency may take action against the license. This action
may include revoking the license, suspending it, placing the licentiate on probation
or taking such other action in relation to the licentiate as the licensing agency,
in its discretion deems proper."
In many instances, the examining psychiatrist will indicate a physician needs therapy
or medication management. The question we then pose is, can the physician practice
safely without therapeutic or other types of intervention? If the answer is yes,
the matter is closed. If the answer is no, then the board files an accusation so
that this condition can be imposed in order to insure patient safety.
Anger has even invented a new classification of doctors, the "disruptive physician."
This term has become so commonplace that it yielded about 986,000 hits on a Google
search. The disruptive physician is the one who blames everyone except him or herself
for everything that goes awry. This is the physician who has tantrums, the one who
lambasts nurses for calling with concerns about patients; the one who throws instruments.
These individuals can and do impact patient care. They subject themselves, and others,
to liability for creating a hostile work environment. They can intimidate nurses,
for example, from contacting the physician with a concern about a patient. We've
seen several cases where nurses were afraid to contact an obstetrician about a worrisome
fetal monitor strip for fear of being ridiculed or chastised. Some of these cases
resulted in fetal and/or maternal demise.
I recently investigated a case where the subject was alleged to be caustically abusive
to O.R. staff, and especially to the residents he was charged with mentoring. I
had no difficulty establishing that this physician was remarkably proficient in
spewing insults and bruising egos. My job, however, was to determine whether or
not his volatile personality traits imposed on his ability to treat patients safely.
In that sense, no correlation could be made. I found it interesting, though, that
during the interview, the physician suggested his behavior with residents imparted
his prodigious work ethic. He sincerely believed he was teaching the residents to
care as much as he did. He admitted he could be harsh but he believed his tactics
yielded conscientious and hard-working practitioners. I questioned whether the turmoil
he caused in the O.R., the fear his outbursts generated, and the stress of deflecting
(or absorbing) his acerbic critiques extracted the best performance from those he
As with every sin, we all experience anger. What makes us different is how we respond
to it. Could you be considered a disruptive physician? What is interesting about
this phenomenon is that those who are disruptive often don't recognize it. I suppose
that component of denial can be attached to the unique personality of the disruptive
person, but I also believe it derives from the failure of colleagues and friends
to communicate honestly when observing behavior that passes beyond the threshold
of good taste and decorum. We are often reluctant to confront inappropriate behavior,
no matter how destructive it is.
There are numerous anger management courses available to the general public, but
the University of California, San Diego has a unique course that addresses anger
management for healthcare professionals. It is offered at their Physician Assessment
and Clinical Education Program (PACE) and participants receive Category 1 continuing
medical education credits. Instituted in February 2005, approximately 48 physicians
have participated, most of whom were referred by Medical Executive Committees. If
you or someone you know might benefit from this course, additional information can
be obtained from PACE's Web site: firstname.lastname@example.org.
Coming up next: Gluttony.