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The Disruptive Orthopaedic Surgeon: Implications for Patient Safety and Malpractice Liability
Pranay Patel, MS1; Brooke S. Robinson, MPH1; Wendy M. Novicoff, PhD2; Gary L. Dunnington, MD1; Michael J. Brenner, MD1; Khaled J. Saleh, BSc, MD, MSc, FRCS(C), MHCM1
1 Division of Orthopaedics, Department of Surgery, Southern Illinois University School of Medicine, 701 North 1st Street, Springfield, IL 62702. E-mail address for K.J. Saleh: ksaleh@siumed.edu
2 University of Virginia School of Medicine, P.O. Box 800159 HSC, Charlottesville, VA 22908
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Nov 02;93(21):e126 1-6. doi: 10.2106/JBJS.J.01933
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Disruptive physician behavior imperils patient safety, erodes the morale of other health care providers, and dramatically increases the risk of malpractice litigation. Increasing patient volume, decreasing physician reimbursement, malpractice litigation, elevated stress, and growing job dissatisfaction have been implicated in disruptive behavior, which has emerged as one of the major challenges in health care. Because the aging patient population relies increasingly on orthopaedic services to maintain quality of life, improving professionalism and eradicating disruptive behavior are urgent concerns in orthopaedic surgery. Although many steps have been taken by The Joint Commission to improve patient care and define disruptive behavior, there is further room for improvement by physicians. Barriers to eliminating disruptive behavior by orthopaedic surgeons include fear of retaliation, lack of awareness among the surgeon's peers, and financial factors. Surgeons have a duty to address patterns of negative peer behavior for the benefit of patient care. This manuscript addresses the causes and consequences of disruptive physician behavior as well as management strategies, especially in orthopaedic surgery.

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