Improving professionalism among physicians and surgeons

Unprofessional behaviors in the health care setting pose a serious threat to patient care. They can result in adverse patient outcomes, decreased physician and staff productivity, and increased turnover. But strategies can be used to decrease and even eliminate unprofessional behaviors.

A study published in the February 2020 issue of The Joint Commission Journal on Quality and Patient Safety—“A professional development course improves unprofessional physician behavior”—shows how a program for distressed physicians (PDP) helped positively modify physicians’ unprofessional behavior.1

Several studies have shown that the most common unprofessional behavior is not the egregious type that we associate with the term. Typically, this behavior does not involve a direct insult, throwing an instrument, or threatening someone physically. Instead, it is the repetition of relatively low-level unprofessional behavior that causes the greatest harm. Research has shown the following:

  • Approximately 95 percent of respondents to a 2004 American College of Physician Executives survey experienced “disturbing” or “dangerous” behaviors.2
  • In a 2013 Institute for Safe Medication Practices survey, 77 percent of respondents encountered colleagues who were reluctant to or refused to answer questions or return calls, with 13 percent stating they encountered it often.3
  • In that same survey, 68 percent reported having experienced condescending language or demeaning comments or insults, and 15 percent said they experienced it often.3

Unprofessional behaviors

In The Joint Commission Sentinel Event Alert Issue 40, “Behaviors that undermine a culture of safety,” examples of unprofessional behaviors included reluctance or refusal to answer questions and return phone calls or pages, condescending language or voice intonation, and impatience with questions.4

The environment in which physicians work, the nature of their job, the regulatory requirements, and the many hours devoted to work are elements that facilitate the occurrence of these behaviors, and though not necessarily meant to be exculpatory of unprofessional behaviors, it is advisable that hospital leadership try to monitor and minimize the stressors.

As reported in the Journal article, a pre-post study design was used to measure changes in physicians’ unprofessional behaviors using the B29, a 35-item, web-based survey.4 The survey was completed as a 360-degree assessment by peers, colleagues, administrators and staff, and a self-assessment from the physician.4 Between the pre- and postsurvey, physicians completed the PDP.4 The three-day course, followed by three one-day sessions spread over six months, taught physicians how to do the following:1

  • Replace unprofessional behavior with professional behavior
  • Promote peer accountability and support
  • Identify risk factors and prevention strategies
  • Practice new skills
  • Promote effective leadership skills

According to postsurvey results, 24 of 28 physicians improved their professional behavior. The mean decrease in unprofessional behavior for all 28 physicians was 51.1 percent and lowest-rated items improved an average of 53.5 percent overall.1

Negative behaviors that declined after the PDP included egregious behaviors and passive-aggressive behaviors. Positive behaviors that increased after the PDP included teamwork, peer relations, and patient/family orientation and empathy.1

For the team to function at a high-performance level, everyone needs to act with respect, to respond to questions, to answer pages, and to avoid behaviors that demean or minimize the work of other members of the team.

The study authors—William H. Swiggart, MS, and coauthors—concluded that “systematic education of physicians in emotional intelligence, self-awareness, introspection, interpersonal skills, conflict resolution, leadership, self-care, emotional regulation, and mindfulness can lead to behavior change in the clinical environment.”1

My take as a surgeon is positive. Very few places in health care rely more on effective teamwork than the operating room. For the team to function at a high-performance level, everyone needs to act with respect, to respond to questions, to answer pages, and to avoid behaviors that demean or minimize the work of other members of the team. Put another way, it is our responsibility to create a positive work environment. The fact that we have ways in which we can educate ourselves, modify our behaviors, and express ourselves in a professional way is encouraging.

To read the study, visit The Joint Commission website.


The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.


  1. Swiggart WH, Bills JL, Penberthy JK, Dewey CM, Worley LLM. A professional development course improves unprofessional physician behavior. February 2020. Joint Comm J Qual Pat Saf. 2020;46(2):64-71.
  2. Weber DP. Poll results: Doctors’ disruptive behavior disturbs physician leaders. Physician Executive. 2004;30(5):6-14.
  3. Institute for Safe Medication Practices. Unresolved disrespectful behavior in healthcare—practitioners speak up again (part 1). October 3, 2013. Available at: Accessed February 26, 2020.
  4. The Joint Commission. Sentinel Event Alert, Issue 40: Behaviors that undermine a culture of safety. Available at: Accessed February 26, 2020.

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