Mona Stecker
  1. Department of Patient Safety, Quality and Innovation, Winthrop University Hospital, 222 Station Plaza North, Suite 408, Mineola, NY 11501, USA

Correspondence Address:
Mona Stecker
Department of Patient Safety, Quality and Innovation, Winthrop University Hospital, 222 Station Plaza North, Suite 408, Mineola, NY 11501, USA


Copyright: © 2015 Stecker M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

How to cite this article: Stecker M. Disruptive behavior. Surg Neurol Int 25-Jun-2015;6:

How to cite this URL: Stecker M. Disruptive behavior. Surg Neurol Int 25-Jun-2015;6:. Available from:

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Recently I participated in a listserv targeted at a narrow audience of subspecialty physicians. It was fun and instructive to understand what problems were arising in this subspecialty area and hear the discussion from many eminent physicians in that area about how to solve them. Although most of the participants enjoyed this interaction, 5–10% of the respondents were openly hostile and accusatory to the physicians who were involved in the discussions! This disruptive behavior on the part of a few served only to halt useful and helpful discourse and prevent others from participating in an open and educational dialog.

This observation is not isolated. Disruptive behavior is a very common problem throughout all of medicine in one form or another. Lack of appropriate discussion between physicians is at the heart of the communication problems that are responsible for many of medical errors. The real problem, however, goes much deeper than this. If physicians do not communicate in a respectful manner to their colleagues, is it really possible that their interactions with patients can be courteous and respectful? Many patients with serious medical problems are emotionally vulnerable. Even a slight problem with communication can cause long-term harm to the patient who may not be told in understandable terms why tests are being done, or what the actual diagnosis and prognosis are. I have seen many patients who consulted a physician and were so put off by their attitude that they did not return to that physician or any other, leaving their problem untreated.

As a group and as individuals, physicians must act NOW to eliminate disruptive behavior. We can no longer tolerate it in any form or forum. We are the leaders and if we allow this behavior to continue, other providers will also feel that disruptive behavior is acceptable. Physicians are a highly educated group and we cannot simply dismiss disruptive behavior. Disruptive behavior occurs only because we as a group continue to permit it. If action were taken in each case, the disruptive behavior would disappear as would the resultant problems in medical care.

Is it difficult to determine when behavior is disruptive? NO. A simple rule is that if another person tells a provider that their behavior crosses a line or makes them uncomfortable, the behavior must stop immediately. Continuing such activity beyond this warning constitutes disruptive behavior. The details of who is “right” or “wrong” can be settled later when all parties are calm and collected. When a patient is in jeopardy, disruptive behavior cannot be tolerated and the supervisors of those involved must be available to “cut through the issues” and advocate for patient safety and quality of care.

Let’s take a ZERO TOLERANCE stand NOW! We can’t just make policies. We have to make it clear that each and every violation is serious and will lead to serious consequences to the provider. Patient safety depends on it!


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    Miguel A. Faria, M.D.

    Posted July 17, 2015, 12:56 pm

    Respectfully, this “article” does not have significant details to allow the reader to render an informed judgment about what really went on. It seems, frankly a holier-than-thou outburst for what may be discourtesy or nonconformist behavior! What exactly was the disruption that eventually rendered the judgement of “zero tolerance”? In fact, Stecker is correct that courtesy and civility are on the decline, but the egalitarian zeitgeist of our time empowers everyone to have opinions, as misinformed as they might be, and to remonstrate, as obnoxiously as they want — i.e, as long as the opinions and remonstrations are not political incorrect!

    Yes, courtesy and civility paradoxically are on the decline, while political correctness and the curtailment of informed political and social speech advances on the aegis of the intelligentsia.

    Stecker writes: “5–10% of the respondents were openly hostile and accusatory to the physicians who were involved in the discussions.” What was said or done? Who were these respondents? Were they participants or not, physicians, patients, or general public? Hecklers or violent individuals should be escorted out of the premises, but dissenting voices should be allowed to speak and express contrary views.

    Stecker writes, “Many patients with serious medical problems are emotionally vulnerable.” True but were patients involved in the listserv discussion or is she now speaking in general terms? She goes from a seemingly specific incident to broad general accusations involving patient care and safety! When did the discussion move from one to the other? This is absolutely not clear.

    Moreover, Stecker uses two disturbing terms that require further explanation. “Disruptive physicians” was a term that came into vogue a couple of decades ago, applied by the leaders of the progressive and elitist AMA (“organized medicine”) and their medical publications to silence, intimidate, and even censure nonconformist physicians, who expressed disapproval of the organizations’ direction or who refused to play the role of sheep in the herd.

    Civility and courtesy are one thing, and I am all for them, but censorship for voicing contrary opinions that may divert the discussion in a direction different from that intended, and thus termed a “disruption,” is another. Let me give you an example. I remember participating in a discussion on universal health coverage at the time of the promotion of HillaryCare and the secret health care task force in 1994, but “sources of funding (i.e., more taxation)” was not permitted in the discussion. When I insisted that it be discussed, I was called “disruptive” by one of the promoters of socialized medicine. The participants sided with me. At the conclusion of the conference, it was decided that universal health insurance in the U.S. was too expensive for the alleged benefits and that improving access was more feasible!

    The other trendy and politically correct but short-sighted authoritative term is even more disturbing —i.e., “zero tolerance.” This simulacrum of authoritative justice has been responsible for school children being reprimanded and suspended from schools for bringing a water gun to class or drawing a picture of a firearm, or even for expressing politically incorrect opinions or religious faith, while brawlers and bullies were and are permitted to wreak havoc, intimidate classmates and truly disrupt classes with melees and general delinquency. “Zero tolerance” is an authoritarian “one size fits all” rather than measured and thoughtful punishment fitting the transgression.

    I hope this reply is taken just as a contrarian view, intending to dissent as well as to inform (while attempting its utmost to remain courteous) rather than deride or disrupt. Free speech and the right to express opposite views is too important to liberty to persiflage or relinquish in silence. No disrespect or lampoonery was intended to offend the author of this editorial!

    Miguel A. Faria, M.D.


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