Patients mutter words like these under their breath as they leave the office or sound off when they get home. At the nurses’ station, feelings of resignation and exasperation are in the air. When is he ever going to stop acting that way? Dr. Diss (a fictional physician archetype) is usually a man. He has always been this way, and his abrasive behaviors seem to be getting worse with time. His technical skills and medical acumen are superior; often, he’s a rainmaker, a surgeon, or a proceduralist who brings fortune and fame to the practice, the hospital, or the medical school. He is considered untouchable. Although some physicians who fit this profile may say or do highly inappropriate things, and others may be frank bullies, many manage to avoid behaving in ways that lead to disciplinary action. Everyday Diss, MD is commonly described with one or more of the ‘diss’ adjectives: Dismissive, disrespectful, or disruptive, as well as with words like arrogant, critical, irritable, self-centered, touchy, and volatile. How did Dr. Diss get this way? Although not all dismissive physicians are the same, in my experience, many of them have a similar history. As pre-med undergraduates, these guys excelled, and they were admitted to top medical schools. Although a bit cocky as medical students, they worked hard to stand out. They were recognized by senior residents and faculty members as hot prospects for highly competitive training programs. In fact, some of the luminaries who vouched for them may themselves be “a bit rough around the edges.” As a dissin’ physician’s high-powered medical career continues to gain altitude, his swagger, and uncivil behavior gradually increase. The more prominent he becomes, the more his bad behavior tends to be rationalized away. Complaints (few and far between, because of the fear factor) may lead to occasional sit-downs with leaders, and he tones things down for a while. But his problematic behaviors eventually resurface. When asked to go for help, he pushes back in a way that conveys a clear message: “Don’t you dare tread on me!” When a system, together with a community of colleagues and leaders, collectively fails to extinguish a physician’s problematic behaviors, those behaviors are inadvertently reinforced. Source
