Doctors have a horrible track record in their profession of recognizing physicians with difficult personalities and dealing with them effectively

Some doctors yell and scream. Some throw surgical instruments. They berate nurses, other health care workers and even patients with snide remarks and insults.

In many cases, the doctors who exhibit these types of disruptive behaviors are seldom punished, according to results of a new national survey that examines physician behavior problems.

When doctors are punished, they are routinely treated more leniently than other staff members because of their professional stature, the survey found.

Conducted by the American College of Physician Executives (ACPE), the survey drew more than 1,600 responses from physician executives working in hospitals, group practices, health systems and clinics across the country. Physician executives are doctors who hold management positions and oversee other doctors. With 10,000 members, ACPE is the nation's largest health care association for physician leaders.

"We have a horrible track record in our own profession of even recognizing physicians with difficult personalities, much less dealing effectively with them," wrote one of more than 300 physician executives who submitted comments with their completed surveys.

Survey respondents emphasized that most doctors get along well with patients, nurses and other health care workers. However, the few bad apples that can be found in almost any health care organization can cause ongoing problems.

Fully 70 percent of survey respondents reported that physician behavior problems nearly always involve the same doctors over and over again. One in three survey respondents said they observe problems with physician behavior either weekly (14%) or monthly (18%).

"This has been a chronic problem that is acutely getting much worse," wrote another survey respondent. "The stress of our jobs (I am a surgeon) is increasing due to the decrease in reimbursement for professional activities, increasing regulatory requirements and severe financial constraints placed upon the hospitals."

Results of the survey are included in a special series of articles in the September/October issue of The Physician Executive, ACPE's journal of medical management.

Survey co-authors Timothy Keogh, PhD, of Tulane University and William Martin, MPH, PsyD, of DePaul University teach ACPE-sponsored courses on how to tackle behavior problems. They say coaching physicians on appropriate behavior, mediating disputes between doctors, nurses and other staff, referring problem physicians to counseling and taking firm disciplinary measures against the offenders are keys to reducing behavior problems.

"The focus is never directed toward the person, only toward the behavior. It is far easier to change behavior than it is to change personality," Keogh and Martin write.