Out of respect for those who serve and protect the health of our nation, let me first say that the use of the term disruptive referring to nurses and doctors who present with anger management problems oversimplify a much more complex problem that needs a deeper analysis. William Bridges in his book Transitions, describes change as having three distinct components —the end, neutral zone and the beginning. He further purports that the neutral zone is the most difficult stage where the person or system going through the change is in a kind of no mans land, trying to find its place to a new beginning. Let me suggest that our country’s health care system is in that no mans lands. While I will never excuse the abusive behavior that is displayed by some doctors or nurses, it is helpful to determine the roots of this emerging problem.
Anger management problems are always associated with problems managing stress, not knowing how to communicate effectively and poor emotional intelligence. My work with doctors, and the discussion with colleagues who have also done extensive work with doctors, suggest that the stress associated handling the changing face of health care is a major contributor to anger management problems.
There was a time when the health care professional said they needed to perform a procedure, they were not questioned. The resources were made available to make this treatment a reality. Such power reinforced the elevated view that was held of health care professions, especially the medical doctor. Such supremacy was not to last forever, because the advent of manage care limited the power of the doctor and placed some of this power in the hands of insurance providers who ultimately may determine care based on economics and medical necessity. Other stressors include doctors whose skills suddenly become obsolete because of technology, shortages of nursing staff, lower reimbursement rates form insurance companies, the threat of lawsuits, rising insurance premiums and the changing hospital culture that requires doctors to display more restraint during periods of frustration.
Some medical professionals tend to have difficulty adapting to such changes and fall victim to anger outbursts towards colleagues and even patients. It may not be in the hands of doctors and nurses to change the system, but it is their responsibly to have the skills to adapt. Therefore seeking help to improve stress management, communication skills and emotional intelligence may be one option to manage the changes that plague the health care system.
Carlos Todd, LPC, NCC, CAMF
President of the American Association of Anger Management Providers
Anger Management/Executive Coaching of Charlotte, North Carolina