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Cooper WO, Hickson GB, Dmochowski RR, Domenico HJ, Barr FE, Emory CL, Gilbert J, Hartman GE, Lozon MM, Martinez W, Noland J, Webber SA. Physician Specialty Differences in Unprofessional Behaviors Observed and Reported by Coworkers. JAMA Netw Open 2024; 7:e2415331. [PMID: 38842804 DOI: 10.1001/jamanetworkopen.2024.15331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Importance Because unprofessional behaviors are associated with patient complications, malpractice claims, and well-being concerns, monitoring concerns requiring investigation and individuals identified in multiple reports may provide important opportunities for health care leaders to support all team members. Objective To examine the distribution of physicians by specialty who demonstrate unprofessional behaviors measured through safety reports submitted by coworkers. Design, Setting, and Participants This retrospective cohort study was conducted among physicians who practiced at the 193 hospitals in the Coworker Concern Observation Reporting System (CORS), administered by the Vanderbilt Center for Patient and Professional Advocacy. Data were collected from January 2018 to December 2022. Exposure Submitted reports concerning communication, professional responsibility, medical care, and professional integrity. Main Outcomes and Measures Physicians' total number and categories of CORS reports. The proportion of physicians in each specialty (nonsurgeon nonproceduralists, emergency medicine physicians, nonsurgeon proceduralists, and surgeons) who received at least 1 report and who qualified for intervention were calculated; logistic regression was used to calculate the odds of any CORS report. Results The cohort included 35 120 physicians: 18 288 (52.1%) nonsurgeon nonproceduralists, 1876 (5.3%) emergency medicine physicians, 6743 (19.2%) nonsurgeon proceduralists, and 8213 (23.4%) surgeons. There were 3179 physicians (9.1%) with at least 1 CORS report. Nonsurgeon nonproceduralists had the lowest percentage of physicians with at least 1 report (1032 [5.6%]), followed by emergency medicine (204 [10.9%]), nonsurgeon proceduralists (809 [12.0%]), and surgeons (1134 [13.8%]). Nonsurgeon nonproceduralists were less likely to be named in a CORS report than other specialties (5.6% vs 12.8% for other specialties combined; difference in percentages, -7.1 percentage points; 95% CI, -7.7 to -6.5 percentage points; P < .001). Pediatric-focused nonsurgeon nonproceduralists (2897 physicians) were significantly less likely to be associated with a CORS report than nonpediatric nonsurgeon nonproceduralists (15 391 physicians) (105 [3.6%] vs 927 [6.0%]; difference in percentages, -2.4 percentage points, 95% CI, -3.2 to -1.6 percentage points; P < .001). Pediatric-focused emergency medicine physicians, nonsurgeon proceduralists, and surgeons had no significant differences in reporting compared with nonpediatric-focused physicians. Conclusions and Relevance In this cohort study, less than 10% of physicians ever received a coworker report with a concern about unprofessional behavior. Monitoring reports of unprofessional behaviors provides important opportunities for health care organizations to identify and intervene as needed to support team members.
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Affiliation(s)
- William O Cooper
- Departments of Pediatrics and Health Policy, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gerald B Hickson
- Department of Pediatrics, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roger R Dmochowski
- Department of Urologic Surgery, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Cynthia L Emory
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jill Gilbert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gary E Hartman
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Marie M Lozon
- Departments of Emergency Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor
| | - William Martinez
- Department of Medicine, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Janesta Noland
- Department of Pediatrics, Stanford University School of Medicine, California and Stanford Medicine Children's Health, Palo Alto, California
| | - Steven A Webber
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Finlayson AJR, Kim A, Mallory AB, Vandekar S, Martin PR. Changing characteristics of physicians referred for fitness-for-duty evaluation. Gen Hosp Psychiatry 2022; 77:128-129. [PMID: 35636150 DOI: 10.1016/j.genhosppsych.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/14/2022] [Accepted: 05/20/2022] [Indexed: 11/15/2022]
Affiliation(s)
- A J Reid Finlayson
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Comprehensive Assessment Program, for Professionals, Nashville, TN.
| | - Ahra Kim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - April B Mallory
- Vanderbilt Comprehensive Assessment Program, for Professionals, Nashville, TN
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Peter R Martin
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN
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Cooper WO, Hickson GB. Balancing Rights and Responsibilities of Key Stakeholders in Addressing Reports of Disrespect Experienced by Patients. Chest 2022; 162:1140-1144. [DOI: 10.1016/j.chest.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/11/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022] Open
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Dmochowski RR, Cooper WO, Hickson GB. Professionalism, Leadership, and a Pilfered Apple. Jt Comm J Qual Patient Saf 2022; 48:419-423. [DOI: 10.1016/j.jcjq.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022]
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Brenner MJ, Boothman RC, Rushton CH, Bradford CR, Hickson GB. Honesty and Transparency, Indispensable to the Clinical Mission-Part I: How Tiered Professionalism Interventions Support Teamwork and Prevent Adverse Events. Otolaryngol Clin North Am 2021; 55:43-61. [PMID: 34823720 DOI: 10.1016/j.otc.2021.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
At the foundation of clinical medicine is the relationship among patients, families, and health care professionals. Implicit to that social contract, professionals pledge to bring clinical excellence to advance their patients' wellness and healing-and to prevent harm. Patients trust that those privileged to deliver care will do so unwaveringly in service of patients' best interests; however, the incentives and infrastructure surrounding health care delivery can promote or undermine individual performance, teamwork, and patient safety. Modeling professionalism and identifying slips and lapses supports pursuit of high reliability. Part 1, Promoting Professionalism, introduces the first of 3 pillars of advancing the clinical mission.
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Affiliation(s)
- Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA; GTC Quality Improvement Collaborative, Durham, NC, USA.
| | - Richard C Boothman
- Boothman Consulting Group, LLC, Ann Arbor, MI, USA; Department of Surgery, University of Michigan Medical School, Ann Arbor; Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cynda Hylton Rushton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Berman Institute of Bioethics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol R Bradford
- The College of Medicine and James Cancer Hospital and Solove Research Institute; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN, USA
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Austin EE, Do V, Nullwala R, Fajardo Pulido D, Hibbert PD, Braithwaite J, Arnolda G, Wiles LK, Theodorou T, Tran Y, Lystad RP, Hatem S, Long JC, Rapport F, Pantle A, Clay-Williams R. Systematic review of the factors and the key indicators that identify doctors at risk of complaints, malpractice claims or impaired performance. BMJ Open 2021; 11:e050377. [PMID: 34429317 PMCID: PMC8386219 DOI: 10.1136/bmjopen-2021-050377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the risk factors associated with complaints, malpractice claims and impaired performance in medical practitioners. DESIGN Systematic review. DATA SOURCES Ovid-Medline, Ovid Embase, Scopus and Cochrane Central Register of Controlled Trials were searched from 2011 until March 2020. Reference lists and Google were also handsearched. RESULTS Sixty-seven peer-reviewed papers and three grey literature publications from 2011 to March 2020 were reviewed by pairs of independent reviewers. Twenty-three key factors identified, which were categorised as demographic or workplace related. Gender, age, years spent in practice and greater number of patient lists were associated with higher risk of malpractice claim or complaint. Risk factors associated with physician impaired performance included substance abuse and burn-out. CONCLUSIONS It is likely that risk factors are interdependent with no single factor as a strong predictor of a doctor's risk to the public. Risk factors for malpractice claim or complaint are likely to be country specific due to differences in governance structures, processes and funding. Risk factors for impaired performance are likely to be specialty specific due to differences in work culture and access to substances. New ways of supporting doctors might be developed, using risk factor data to reduce adverse events and patient harm. PROSPERO REGISTRATION NUMBER PROSPERO registration number: CRD42020182045.
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Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Vu Do
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - Tahlia Theodorou
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Annette Pantle
- Medical Council of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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White AA, Sage WM, Mazor KM, Gallagher TH. Assessing and Supporting Late Career Practitioners: Four Key Questions. Jt Comm J Qual Patient Saf 2020; 46:591-595. [PMID: 32859507 DOI: 10.1016/j.jcjq.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
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Devi G, Gitelman DR, Press D, Daffner KR. Cognitive Impairment in Aging Physicians: Current Challenges and Possible Solutions. Neurol Clin Pract 2020; 11:167-174. [PMID: 33842070 DOI: 10.1212/cpj.0000000000000829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/11/2020] [Indexed: 11/15/2022]
Abstract
Aging physicians are at a higher risk of cognitive impairment, undermining patient safety and unraveling physicians' careers. Neurologists, occupational health physicians, and psychiatrists will participate in both health system policy decisions and individual patient evaluations. We address cognitive impairment in aging physicians and attendant risks and benefits. If significant cognitive impairment is found after an appropriate evaluation, precautions to confidentially support physicians' practicing safely for as long as possible should be instituted. Understanding that there is heterogeneity and variability in the course of cognitive disorders is crucial to supporting cognitively impaired, practicing physicians. Physicians who are no longer able to practice clinically have other meaningful options.
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Affiliation(s)
- Gayatri Devi
- Park Avenue Neurology (GD), New York City, NY; Advocate Lutheran General Hospital (DRG), Chicago, IL; Beth Israel Deaconess Medical Center (DP), Boston, MA; and Brigham and Women's Hospital (KRD), Boston, MA
| | - Darren R Gitelman
- Park Avenue Neurology (GD), New York City, NY; Advocate Lutheran General Hospital (DRG), Chicago, IL; Beth Israel Deaconess Medical Center (DP), Boston, MA; and Brigham and Women's Hospital (KRD), Boston, MA
| | - Daniel Press
- Park Avenue Neurology (GD), New York City, NY; Advocate Lutheran General Hospital (DRG), Chicago, IL; Beth Israel Deaconess Medical Center (DP), Boston, MA; and Brigham and Women's Hospital (KRD), Boston, MA
| | - Kirk R Daffner
- Park Avenue Neurology (GD), New York City, NY; Advocate Lutheran General Hospital (DRG), Chicago, IL; Beth Israel Deaconess Medical Center (DP), Boston, MA; and Brigham and Women's Hospital (KRD), Boston, MA
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Hickson GB, Peabody T, Hopkinson WJ, Reiter CE. Cognitive Skills Assessment for the Aging Orthopaedic Surgeon: AOA Critical Issues. J Bone Joint Surg Am 2019; 101:e7. [PMID: 30653052 DOI: 10.2106/jbjs.18.00470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Physician leaders are increasingly confronted with the challenge of evaluating the performance of surgical colleagues during the last phase of their careers. Identification of physicians with declining cognitive and clinical skills must be balanced against awareness of laws protecting colleagues from discrimination. Responding successfully to this challenge requires appropriate policies, reliable data, standardized evaluation tools, consistent documentation, and the development of compassionate and effective solutions that avoid discriminatory practices. Surgical champions are essential for promoting self-regulation. Performance evaluations should comply with medical staff bylaws and institutional wellness policies.
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White AA, Sage WM, Osinska PH, Salgaonkar MJ, Gallagher TH. Patient safety and the ageing physician: a qualitative study of key stakeholder attitudes and experiences. BMJ Qual Saf 2018; 28:468-475. [PMID: 30237318 DOI: 10.1136/bmjqs-2018-008276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/20/2018] [Accepted: 08/12/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Unprecedented numbers of physicians are practicing past age 65. Unlike other safety-conscious industries, such as aviation, medicine lacks robust systems to ensure late-career physician (LCP) competence while promoting career longevity. OBJECTIVE To describe the attitudes of key stakeholders about the oversight of LCPs and principles that might shape policy development. DESIGN Thematic content analysis of interviews and focus groups. PARTICIPANTS 40 representatives of stakeholder groups including state medical board leaders, institutional chief medical officers, senior physicians (>65 years old), patient advocates (patients or family members in advocacy roles), nurses and junior physicians. Participants represented a balanced sample from all US regions, surgical and non-surgical specialties, and both academic and non-academic institutions. RESULTS Stakeholders describe lax professional self-regulation of LCPs and believe this represents an important unsolved challenge. Patient safety and attention to physician well-being emerged as key organising principles for policy development. Stakeholders believe that healthcare institutions rather than state or certifying boards should lead implementation of policies related to LCPs, yet expressed concerns about resistance by physicians and the ability of institutions to address politically complex medical staff challenges. Respondents recommended a coaching and professional development framework, with environmental changes, to maximise safety and career longevity of physicians as they age. CONCLUSIONS Key stakeholders express a desire for wider adoption of LCP standards, but foresee significant culture change and practical challenges ahead. Participants recommended that institutions lead this work, with support from regulatory stakeholders that endorse standards and create frameworks for policy adoption.
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - William M Sage
- Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA.,School of Law at the University of Texas at Austin, Austin, Texas, USA
| | - Paulina H Osinska
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Monica J Salgaonkar
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Thomas H Gallagher
- Departments of Medicine and Bioethics, University of Washington School of Medicine, Seattle, Washington, USA
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Collier S. Invited Perspective on "Unsolicited Patient Complaints Identify Physicians with Evidence of Neurocognitive Disorders". Am J Geriatr Psychiatry 2018; 26:937-938. [PMID: 29980477 DOI: 10.1016/j.jagp.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
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