The day this physician was labelled as disruptive


There can be little doubt that these days that political correctness has run rampant. Terms like “racist,” “sexist,” or “homophobic” are thrown around so frequently and early now that one has to wonder what is actually being accomplished. If you were to ask a physician what PC label they most fear, it would be “disruptive.”

Let’s face it. We are no longer allowed to get angry, raise our voice, or express any frustration for whatever reason. Granted, some physicians boiling points are lower than others, but how we are expected to bear full responsibility for outcomes while losing control of the process is beyond me.

This is the story of the day I was labeled disruptive. For my entire career, our group covered our local hospital’s emergency room. We had one request. Please call us for every patient with an orthopedic problem that you intend to refer or admit so that we could properly evaluate the patient. This became much easier once we got computer access to the x-rays. Call us if you are not sure what you are seeing. We also had a reputation of responding quickly. To any outside observer, this should make logical sense. We could properly evaluate the situation and give optimal instructions especially since we were the providers who would take principal responsibility for the outcome. These instructions went something like this: “That’s a (fracture, sprain … etc.). Please (apply a splint and send to office; admit to hospital and prepare for surgery; refer to a trauma center, since that is too complex an injury to treat here).

Makes logical sense, right? However, for years this was violated with excuses: the ER was too busy to call, or Medicare does not want us to keep patients in the ER too long. This resulted in a number of different issues ranging from patients with significant injuries whose treatment was delayed because they did not show up to our office for weeks, to patients being admitted to the hospital without our knowledge and needing surgery without being properly prepared.

In any case, our response was the same. A phone call or letter was sent to the ER and administration stating, “Dear Dr. Jones, on (date) patient (John Doe) was seen in the ER with (injury). We were not called as we have repeatedly requested resulting in (sub-optimal care). As you know, we have consistently requested that we be contacted from the ER for any and all orthopedic patients so that proper disposition can be achieved. We consider this a patient safety issue and will take whatever steps necessary to ensure appropriate care.”

For a few weeks things changed but it did not take long for the ER to slip back into its old habits. Our response remained consistent.

One particularly busy weekend, I was in the OR doing a case when I received word that there was another patient in the ER who may need admission and possible surgery. Since I was tied up operating, my instructions were to leave the patient in the ER until I was done in about an hour, and I would come down to evaluate. Emphasize one hour. Tired and in no mood for excuses, imagine my reaction when I found out the patient was admitted against my explicit instructions to wait until I got to the ER to evaluate.

To put it mildly, I lost it. I won’t go into details but suffice to say they heard me our other hospitals ER a couple of miles away.

Fortunately, there was no harm done to the patient but you can guess what happened next. I got the dreaded label of “disruptive” by mail. The letter, signed by the head of the ER, head of the surgical department and hospital CEO read, “Dear Dr., On (date) you (disrupted the ER) . This is not acceptable. We will have no choice but to label you as disruptive, and we will take whatever steps necessary to correct including potential loss of privileges, reporting you to the state licensing board, etc.”

My response: “Dear (same three people). As you are aware what happened on (date) is the result of the ERs continual refusal to follow our simple request to wait until we have the chance to properly evaluate orthopedic patient prior to disposition by the ER. As we have well documented, we consider this a patient safety issue. I will be more than happy to apologize for my outburst if we get, in writing, a promise from the ER that this will never happen again. If you do not, and action is taken against me, I will have no choice but to report what your ER is doing, with the apparent approval of administration, to (any group I could think of) as a patient safety issue.”

Weeks went by before I received a response. Although long in content the conclusion was, “We consider the matter closed” and the ER started to consistently call us.

The takeaway lesson: As long as you know you can defend what you doing, never give into a PC attack. If we are doomed to live in a PC world, then find a PC term that your accuser fears just as much: in this case, hospital and patient safety. Hopefully, one day we will learn to stop using inflammatory language to intimidate each other but, unfortunately, that day is not today and, if anything, it is getting worse.


Thomas D. Guastavino is an orthopedic surgeon.

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