It’s 3:00 a.m. in the ER. The trauma bay is overflowing, two nurses have called out sick and the EMR is lagging. A surgeon storms in, throwing a retractor and berating a resident for a minor delay in gathering supplies. The room goes silent, and the focus shifts from the patient on the table to the physician’s outburst.
This scenario will sound uncomfortably familiar to anyone who has worked alongside a clinician who is technically exceptional but emotionally volatile. They may be brilliant with a scalpel but a nightmare to work with, and their clinical skill often shields them from accountability, even as their behavior erodes team morale and undermines care delivery. Their disruptive behavior can stem from and reflect systemic issues like understaffing and unclear policies rather than simply their temperament, noted one gastroenterologist on Sermo.
Distinguishing between a truly “bad apple” and a capable physician pushed to the breaking point is essential. Doing so allows healthcare leaders and physician peers to respond appropriately—addressing harmful conduct while also repairing the systems that contribute to it—so patient safety and team well-being remain the central focus.
Defining disruption in a clinical setting
The American Medical Association (AMA) defines disruptive physician behavior as “personal conduct, verbal, or physical that has the potential to negatively affect patient care or the ability to work with other members of the healthcare team.” This isn’t a doctor who is simply demanding or strict about standards, but one whose behavior actively dismantles the team’s ability to function.
The label of “disruptive” is often misunderstood and refers specifically to interpersonal impact rather than clinical competence and diagnostic skill. For example, it’s not about whether a central line was placed correctly; it’s about whether the nurse felt psychologically safe enough to mention that the sterile field might have been compromised during the procedure.
In this context, a physician may demonstrate exemplary technical skill while simultaneously undermining team communication and patient safety. Conversely, a physician may struggle with medical accuracy but remain a collaborative team player. The disruptive label focuses exclusively on the former.
Disruption isn’t always overt. While actions like yelling, using abusive language, or physical threats and intimidation are easy to spot, more subtle passive-aggressive conduct can also be damaging. This includes behavior such as refusing to return pages, using a condescending tone, or giving the “silent treatment” during critical handoffs—all of which impede care delivery.
According to Joint Commission standards, disruptive behavior is a threat to patient safety because it creates a “steep authority gradient.” When a hierarchy is enforced through intimidation or dismissal, effective communication isn’t possible. Members of the care team who feel intimidated are significantly less likely to speak up about potential medical errors.
The “distressed” alternative
Some organizations are moving toward the term “distressed behavior” to acknowledge the reality that disruptive conduct is often a symptom of underlying overwork or mental health challenges rather than innate malice. This framing shifts the focus from punishment alone to early identification, support, and remediation—such as peer coaching, workload reassessment, or referral to wellness resources.
We polled the Sermo community to see how pressures in the workplace contribute to this distress, which uncovered the following:
- Understaffing is chronic: 56% of members said they currently work on a short-staffed team.
- The workload is unmanageable: When asked how short-staffing affects workload, 29% said they have to spend more time working outside of hours, and 26% are experiencing increased stress/burnout.
- Burnout is rampant: Only 2% of respondents said they never feel overworked. Meanwhile, 16% feel overworked “all the time,” and 37% “most of the time.”
- The barriers are systemic: When asked what prevents them from providing patient care, 42% cited a “lack of time for individual patient care,” and 21% said burnout.
The impact of disruptions on other physicians
The “distressed physician” model suggests that those in high-stress specialties (such as surgery, emergency medicine, or critical care) may be more prone to behavioral lapses due to sustained pressure and elevated stakes, rather than personality traits alone. No matter the cause, when a physician believes their clinical output outweighs their interpersonal input, the team suffers.
The Sermo community has weighed in on this dynamic. One physician shared their experience: “There’s another doc that I work with on a regular basis that is extremely difficult to get along with,” they write.” This person has a generally condescending attitude, laughs at what you say, and argues with everyone over any esoteric issue…I’ve heard this person do this to other docs, their spouse, and recently even a patient.”
Another physician joined the conversation, wondering in what type of practice the disruptive physician worked. “I’ve always wondered how docs with such attitudes (especially in a referral specialty) can succeed in private practice,” they noted.
A pediatrician also chimed in, offering a suggestion to the original poster: “I had to deal with three similar docs as medical director and I understand how annoying it is,” they shared. “My advice would be writing a written complaint and giving it to his supervisor.”
All three comments highlight how one physicians’ condescending attitude can amount to a negative work environment. Whether it’s due to ego or a coping mechanism for stress, the result requires intervention.
The impact of disruptive doctors on patient safety and teamwork
The consequences of disruptive behavior extend beyond interpersonal discomfort, hurt feelings, or an unpleasant break room. Intimidation can create a culture of silence in an industry where redundancy and double-checking are the fail-safes against fatal errors.
If a scrub technician hesitates to report a potential breach in sterile technique, or a resident avoids clarifying a medication interaction due to fear of reprimand, the risk to patients increases. These breakdowns directly undermine established patient safety frameworks that depend on shared vigilance and open communication.
Research shows that the issue is common. In one study that surveyed 7900+ health care workers, disruptive behaviors were reported in 97.8% of work settings.
One Sermo member shared an example of how leadership can weaponize this behavior. “The last CNO at my recently discharged from facility would file claims with the state nursing board against any nurse who spoke against her or questioned policies,” they recount. “Luckily the CNO got fired for retaliation against the wrong nurse but was released as an ‘early retirement’.”
This is the extreme end of the spectrum, but even minor rudeness can also disrupt care, as illustrated by another Sermo member’s comment: “While I was doing an exam on a patient, another physician walked in and started talking with the patient without addressing me (as if I am not in the room). He actually also started examining the patient. Very rude. I had to say ‘excuse me, can I finish’. It was very awkward for the patient.”
How to deal with disruptive physicians in the workplace
When dealing with a disruptive physician, it is important to first separate the behavior from the individual person. Is this a pattern of abuse, or is this a colleague advocating for patient safety in a clumsy way? The best path forward for each differs, according to a radiologist and Sermo member. “A doctor with anger issues may well have to be restricted or fired, but a doctor who is a PITA because they are looking out for the very errors that can drag the hospital down should be listened to,” they write.
Formal recourse becomes necessary when physicians cross a line into disrespect or create risk. One Sermo member shared a real-world dilemma with the Sermo community. “There’s a new mid-level at my center who has been rude and disrespectful to me since they got here,” they write. “Even going so far as to correct me in front of patients… Has anyone else dealt with this situation? What did you do?”
In response, the community shared practical advice:
- Address it directly: “I would try to pull her aside one on one, and ask her if everything is ok, and give her a couple of minutes to respond… use ‘I’ words (‘I’ feel like there’s some friction between us, etc… as opposed to ‘you are being rude’),” suggested an internal medicine physician.
- Set boundaries: Another Sermo member suggested pulling the physician aside to let them know that they are coming across in a disrespectful way, “and if he/she does not agree with your treatment or assessment of patients that he/she discuss that with you privately rather than in front of patients.”
- Escalation and documentation: “Go to the MD supervisor,” an ophthalmologist advised. “Use the simple statement that the midlevel has contradicted you in front of patients. Ask that this ‘risky’ behavior be addressed. Leave everything personal out of it. Make a note of whom you spoke to, date and time, what you said, what they said.” Similarly, a radiation oncologist recommended sitting down with a third-party to discuss the incident.
Your workplace likely has safeguards in place. Peer review processes exist not just to punish, but to investigate. To ensure managing difficult colleagues doesn’t turn into a witch hunt, hospitals must have clear bylaws. The Joint Commission requires accredited hospitals to maintain codes of conduct to manage disruptive behaviors without acting on malicious reports filed in retaliation. While the peer review system isn’t always perfect — biases can affect the process — it’s designed to assure quality care, one study points out.
Key takeaways for physicians
Addressing disruptive behavior is not a matter of workplace popularity. A pleasant, respectful work environment translates to reduced staff turnover, improved team performance, and even lower litigation risk. By contrast, even highly skilled physicians whose conduct is consistently inappropriate may expose themselves and their institutions to increased legal risk.
Importantly, the designation of “disruptive” behavior is intended as a framework for identification and remediation—not as a personal judgment. It’s a signal that something is wrong—either with the physician’s coping mechanisms and individual stress responses or the pressures of the clinical environment they are in. In many cases, it is neither permanent nor career-limiting. Early recognition of one’s own distress-related behaviors can substantially mitigate professional consequences.
A common theme within the discussions on Sermo has been the importance of thorough documentation. Whether you are experiencing disruptive conduct from others or responding to concerns about your own behavior, maintaining clear, objective records is essential.
Moving toward a collaborative culture
In the modern, team-based medical environment, professional conduct is a mandatory patient safety standard, no less essential than hand washing or sterile technique.
Medicine is inherently demanding and stressful, with frequent life-and-death situations, insurance barriers, malfunctioning computers, and staffing shortages. In some cases, poor conduct reflects not individual shortcomings but the cumulative strain of practicing within a stressed system.
Whether you are navigating conflict with a colleague or recognizing early signs of burnout in yourself, peer insight can help clarify next steps. You can bring your unique situation to the Sermo community for feedback. Get advice from peers who have been there, and help build a medical culture that protects and supports both physician well-being and patient safety.
