While healthcare systems in the United States and the United Kingdom vary dramatically, doctors on both sides of the pond experience similar stresses and responsibilities — and, on occasion, similar bad behavior.
Incidents of inappropriate behavior are relatively uncommon in both countries, but physicians say that in recent years they’ve seen slightly more incidents of doctors acting disrespectfully toward patients or coworkers, treating patients’ privacy too casually, expressing anger or aggression at work, and, in some cases, even committing crimes.
But how do the two countries compare? According to Medscape’s new report, Physicians Behaving Badly: US vs UK, US physicians were more likely than their UK peers to say they spotted misbehavior, but the differences aren’t stark. For this survey, nearly 2800 physicians in the United States and the United Kingdom shared with Medscape details of where and how often they see bad behavior among their peers.
Acting Out and Speaking Up
Mistreatment of fellow physicians or medical staff was often cited when respondents were asked whether they had witnessed certain misbehaviors in the past 5 years. This was true for both US and UK physicians, with 86% of US respondents and 83% of UK respondents reporting having witnessed a colleague bullying or harassing clinicians or staff. The category “sexist behavior” wasn’t a choice in the US survey, but 38% of UK doctors reported having seen it.
Mocking or disparaging patients was seen by 82% of US respondents, but only 63% of UK physicians. There was a smaller but still notable gap in incidents of racist language as well, 55% in the United States and 47% in the United Kingdom.
In most categories, US respondents were more likely than their UK counterparts to report bad conduct. One exception was drinking on the job, with 52% of US physicians reporting seeing a colleague inebriated at work against 62% of UK docs reporting having seen this behavior.
When it comes to responding to bad behavior, the results were similar for both groups. All of those surveyed were less likely to lodge an official complaint, oral or written, than to speak privately to the offending doctor or ignore the incident.
An American Medical Association Code of Medical Ethics opinion recommends that US physicians report incompetent or unethical behavior that could put patients at risk. In the United Kingdom, the General Medical Council tells health professionals, “Most concerns about doctors will be handled locally without involving the GMC. However, you should inform us if there is evidence that suggests the doctor may not be fit to practise.” In any case, doctors on both sides of the Atlantic mostly agree that the first course of action in cases of inappropriate behavior should be verbal warnings or management interventions, with formal measures being used only when other measures fail.
“In the UK, we have a process we call ‘speaking up,’ ” said Alexis Paton, PhD, medical ethicist and director of the Centre for Health and Society at Aston University, Birmingham, United Kingdom.
Designated staff members across all trusts and hospitals are available to talk to doctors who’ve witnessed something they think was inappropriate or unsafe. This provides a safe space for doctors to report such incidents, Paton said.
“We know medicine is hierarchical,” Paton said. “This provides a way of stepping out of the system of that hierarchy and saying: ‘I saw this; I’m not sure, but I think it might be wrong,’ and they can have a discussion about that.”
But, she adds, “That’s what it looks like on paper.”
In reality, it’s difficult in the United Kingdom and United States for junior doctors to challenge more senior physicians or for people of color or other minorities to speak up. “We know that in fact our doctors from ethnic minority backgrounds are almost never likely to do this, because they fear some sort of reprisal. And in fact, they’ve experienced it in some way,” Paton says.
Off Duty
Doctors don’t always behave well when off work, either, with mocking others and drunkenness in public outside the office cited as problems in both countries.
However, UK doctors were slightly more likely (23% versus 18%) to spot bad behavior in person in nonmedical settings, whereas US physicians were somewhat more likely to see poor behavior on social media (35% versus 30%). When it comes to which social media site is favored for misconduct, 60% of UK doctors chose none of the mainstream media options as an answer to this question. Facebook was cited most often by US docs. “I see bad behavior almost every time I read an active post on Facebook or Instagram,” noted one respondent to the US survey.
Paton was surprised to see that doctors were misbehaving on Facebook, noting that there aren’t that many professional Facebook groups; on the other hand, a lot of people have a private Facebook presence. “Context matters quite a lot with inappropriate behavior,” she says. However, she was reassured to see that 90% of US doctors and 95% of those in the United Kingdom would not friend a patient on social media.
Despite having noticed bad behavior in others, 80% of doctors surveyed — both in the United States and the United Kingdom — say they don’t believe they themselves behaved inappropriately, either mistakenly or knowingly, during the past year.
Higher Standards
The big question, of course, is why physicians behave badly. Most respondents blamed job-related stress and personal issues, though US respondents were slightly more likely than those in the United Kingdom to cite those challenges as reasons for behaving badly. And, indeed, stress — whether at the clinic or hospital or at home — has reached record levels recently.
“The pandemic became politicized, and healthcare providers were then demonized by the patient population that was misinformed or dis-informed about the realities of COVID,” said M. Sara Rosenthal, professor of bioethics and founding director of the University of Kentucky Program for Bioethics. “This led to extreme moral distress and moral injury within the healthcare population.”
Rosenthal said that, as much as we’d like it to be, we’re not out of the COVID era.
“You’re talking about a very overstressed population. If they can hold it together long enough not to have outbursts with their patients, they snap at their colleagues,” Rosenthal said. “That may be natural under very stressful circumstances.”
Majorities in both the United States and United Kingdom agree that stress may explain bad behavior — but doesn’t excuse it. Two-thirds of respondents in both the United States and United Kingdom say that doctors should be held to higher standards than the general public.
Rosenthal agrees. “Considering what we’re asking them to do and what they’re responsible for, I think medical professionals should be held to higher standards.”
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