Disruptive physician behavior has become a common problem in medicine. Individuals who conduct themselves in a manner that could negatively affect patient care, or "disruptive physicians," frequently cause stress for patients and staff, are a headache for leadership, and can require expensive remediation. We suggest that rather than "bad apples," many disruptive physicians are the fruit of a "toxic tree." That is, many physicians only become disruptive as a response to their environment. It is important for leaders to accurately identify the root causes of disruptive behavior in order to address the problem. In general, it is important for leaders to act prospectively, to examine events from all perspectives, to promote wellness and communication, and to identify external or systemic causes. We also discuss additional considerations for when the physician who has been labeled "disruptive" is a member of an underrepresented group (in orthopaedic surgery, the underrepresented groups are women and racial minorities). As a conclusion, we offer a case example of how 1 institution established a system of physician wellness to enhance prevention efforts.

中文翻译：

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AOA 关键问题研讨会：颠覆性医生：坏苹果还是毒树？


破坏性医生行为已成为医学界的常见问题。行为方式可能对患者护理产生负面影响的个人或“破坏性医生”经常给患者和工作人员带来压力，让领导层头疼，并且可能需要昂贵的补救措施。我们认为，许多破坏性医生不是“坏苹果”，而是“毒树”的果实。也就是说，许多医生只是为了应对他们的环境而变得具有破坏性。领导者必须准确识别破坏性行为的根本原因，以便解决问题。一般来说，领导者必须前瞻性地采取行动，从各个角度审视事件，促进健康和沟通，并确定外部或系统性原因。我们还讨论了当被贴上“破坏性”标签的医生是代表性不足的群体的成员时的其他考虑因素（在骨科手术中，代表性不足的群体是女性和少数族裔）。作为结论，我们提供了一个案例，说明 1 个机构如何建立医生健康系统以加强预防工作。