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Acad Med. 2018 Nov;93(11):1679-1685. doi: 10.1097/ACM.0000000000002126.

Patterns of Disrespectful Physician Behavior at an Academic Medical Center: Implications for Training, Prevention, and Remediation.

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J. Hopkins is clinical professor of medicine, Stanford School of Medicine, and associate chief medical officer and senior medical director for quality, Stanford Health Care, Stanford, California. H. Hedlin is senior biostatistician and associate director, Clinical Trial Program, Quantitative Sciences Unit, Department of Medicine, Stanford School of Medicine, Stanford, California. A. Weinacker is professor of medicine and senior vice chair for clinical affairs, Department of Medicine, Stanford School of Medicine, and associate critical care medical director, associate chief medical officer for patient care services, and interim chief quality officer and service medical director, Stanford Health Care, Stanford, California. M. Desai is professor of medicine, of biomedical data science, and (by courtesy) of health research and policy, and director, Quantitative Sciences Unit, Stanford School of Medicine, Stanford, California.



Physician disrespectful behavior affects quality of care, patient safety, and collaborative clinical team function. Evidence defining the demographics, ethnography, and epidemiology of disrespectful behavior is lacking.


The authors conducted a retrospective analysis of reports of disrespectful physician behavior at Stanford Hospital and Clinics from March 2011 through February 2015. Events were stratified by role, gender, specialty, and location in the hospital or clinics where the event occurred. Event rate ratios were estimated using a multivariable negative binomial regression model. Correlation of rates of faculty and trainees in the same specialty was assessed.


One hundred ninety-nine events concerned faculty; 160 concerned trainees. Events were concentrated among a small number of physicians in both groups. The rates of faculty and trainee events within the same specialty were highly correlated (Spearman's rho: 0.90; P < .001). Male physicians had an adjusted event rate 1.86 (95% CI = 1.33-2.60; P < .001) times that of females. Procedural physicians were 3.67 times (95% CI = 2.63-5.13; P < .001) more likely to have a disrespectful behavior event than nonprocedural physicians when adjusting for other covariates. Most common location for faculty was the operating rooms (69 events, 34%); for trainees, the medical/surgical units (43 events, 27%).


Patterns of physician disrespectful behavior differed by role, gender, specialty, and location. Rates among faculty and trainees of the same specialty were highly correlated. These patterns can be used to create more focused education and training for specific physician groups and individualized remediation interventions.

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