Angry Medicine: Why Anger is a Healthcare Issue

Posted on June 2, 2011 by VITAL WorkLife

Stress Female Ethnic PhysicianWhile anger is a completely normal emotion, the way a doctor expresses it—as well as the intensity and frequency with which it erupts—can have a dramatic impact on your healthcare organization’s bottom line.

According to Vanderbilt University research, unprofessional behaviors are associated with everything from poor adherence to practice guidelines, loss of patients, low staff morale and turnover to medical errors, adverse outcomes and malpractice suits.

“While the Joint Commission demands action when disruptive behavior occurs, many organizations could avoid getting to that point by encouraging doctors to seek counseling when anger first becomes an issue,” explains Dr. Alan Rosenstein, medical director for VITAL WorkLife.

The Hidden Costs of Physician Anger

Another reason for concern about physicians with anger issues is that they’re putting a valuable asset (their own health) at risk:

  • In addition to being associated with habits that increase the likelihood of developing heart disease (including smoking, low levels of physical activity and excessive use of alcohol), anger also produces direct biological effects on the heart and arteries by triggering the release of adrenaline, cortisol and other stress hormones associated with the body’s ”fight or flight” response.
  • High levels of stress hormones contribute to cardiovascular disease in several ways. Not only do they constrict blood vessels and boost blood pressure, they also enhance the clotting potential of the blood, increasing the likelihood that blockages will form in the heart’s arteries.
  • In a 10-year study of healthy veterans at Duke University, men who reported higher levels of anger, hostility and depression showed a steady increase in their levels of C3, a marker of the inflammatory process thought to contribute to the development and progression of heart disease.

What Causes Anger?

Anger is one of the most complex human emotions. Many times anger is an appropriate response to a situational trigger—which can be expressed in either an appropriate or inappropriate manner. Physiological changes associated with anger include elevated heart rate, blood pressure and adrenaline.

Some people anger more easily than others, some are born that way and some develop it over time. There’s evidence that some children are born irritable and touchy and are perceived that way from an early age. Family background can also play a role—people who are easily angered often come from families that are disruptive, chaotic and not skilled at emotional communications.

Common mental or behavioral health issues that may result in increased irritability or difficulty managing anger include:

  • Untreated depression or anxiety
  • Bipolar disorder
  • Chemical dependency
  • ADD or ADHD

Less common and more serious psychiatric disorders associated with anger include borderline, oppositional defiant or antisocial personality disorders, and schizophrenia.

“In cases where anger is a manifestation of more serious underlying mental health issues such as depression, anxiety and personality styles, offering opportunities for assessment and support will be key in addressing these situations effectively,” notes Liz Ferron, senior consultant for VITAL WorkLife.

Normal vs. Pathological Anger

Typically, “normal” anger and “pathological” anger are differentiated by a variety of factors and the relative degree to which those factors come into play, including:
• Pervasiveness: Is it a single, isolated incident or is there anger about a great many things and with a great many people?
• Duration: Is the anger over once expressed, or is there brooding after the fact about the person or event that triggered the anger?
• Communication: Is the anger expressed constructively or does it involve sarcasm, insults, threats or shouting?
• Physicality: Is there an attempt to physically intimidate or injure the person perceived as triggering the anger? Are things thrown or broken in a rage?

“For the most part, anger disorders cannot be blamed on bad neurology, genes or biochemistry. They arise from a failure to recognize and consciously address anger as it arises, before it becomes pathological and dangerous,” said Dr. Stephen A. Diamond, PhD in a 2009 article on anger disorders published in Psychology Today.

What Makes Physicians Angry?

With physicians, the most common “triggers” for anger include:

  • Getting behind schedule
  • Medical complications
  • Unexpected additions to the schedule
  • Nurses or other staff who are not as driven as they are—or who can’t seem to “read their minds”
  • Perceived obstacles to providing patient care—”hoops they have to jump through” to get treatments approved
  • Outdated or inefficient systems and processes
  • Charting in general, and electronic records in recent years
  • Uncooperative patients
  • Hurt or resentment over real or perceived slights

“Regardless of the trigger, a doctor who responds with verbal or physical attacks has an anger management problem and so does the organization employing him or her,” notes Rosenstein.

Anger Management: How Physician Well Being Resources Can Help

Despite training them to treat every conceivable disease during medical school, very little time is spent teaching physicians how to self-soothe or manage their anger.

VITAL WorkLife offers a robust solution, Physician Well Being Resources, designed specifically for physicians and their families. Available 24/7, confidential counseling, peer coaching and support—by telephone or in person.

Healthcare organizations that offer Physician Well Being Resources should encourage clinicians who are struggling with anger issues to take advantage of their resources. In addition to learning anger management techniques, physicians have the option of talking one-on-one with a physician peer coach outside their organization or geographic region at any time or place that’s convenient for them—or whenever an issue occurs.

“Physicians appreciate working with someone who’s walked in their shoes,” explains Rosenstein. “They look to us for real-world solutions they can put to work in their daily lives.”

In addition, Physician Well Being Resources includes a wide range of support services that can prevent or reduce stress in a physician’s life, ranging from marriage and individual counseling to financial and legal services to concierge services designed to maximize the quantity and quality of a physician’s personal time.

Angry Physicians: When Intervention is Needed

In cases where a doctor exhibits explosive anger or other disruptive behaviors, VITAL WorkLife offers a comprehensive Physician Intervention solution designed to help healthcare organizations intervene quickly, compassionately and effectively.

Physician Intervention typically begins with a comprehensive assessment of the troubled physician from a variety of angles. This is conducted using a multi-disciplinary team selected for their expertise in several areas. Once an assessment has been made and an action plan developed, VITAL WorkLife provides services or referrals, as appropriate, plus monitoring and follow up. To learn more, watch our video below: 

“Our preference would be to have doctors refer themselves for help,” notes Rosenstein. “We’d rather be helping doctors improve their satisfaction with their practices and family lives than helping doctors resurrect their reputations and careers after engaging in disruptive behavior.”

We Can Help

For more information on our Physician Well Being Resources or Physician Intervention solutions, contact us or visit our website at VITALWorkLife.com.

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