An exceptional doctor, a difficult colleague: how a hospital director responds to a star clinician’s behaviour

Two dimensions of a specialist’s responsibility

At a team briefing, a highly regarded surgeon ridicules someone who asks about a risk to a patient. The surgeon’s operative skills still matter, but they do not answer whether the team feels able to share important information with them. The hospital director should therefore assess clinical achievements and conduct when working with others separately. An account of the briefing should note whether the question was heard and answered, rather than relying on a general opinion of the doctor. In a retrospective study of 13,653 patients and 202 surgeons at two centres, reports of unprofessional behaviour were associated with subsequent complications. That association warrants attention, but does not prove that the behaviour caused a complication or that a particular conversation would reduce complications.

How status can get in the way of important information

When a specialist publicly dismisses a nurse’s question, it may affect not only the briefing but also the nurse’s willingness to raise another concern. The director should check whether staff still bring concerns to the doctor after such an incident, including concerns about patient safety. In a survey of 23 neonatal intensive care units, professional status was associated with how safe people felt speaking up. Leaders’ behaviours that invited others to participate reduced the significance of status differences. This is a useful pointer when observing ward hierarchies, not a promise of better treatment outcomes. Nor can observational data establish that a supervisor simply asking questions will undo the effects of public humiliation.

What the complication data actually show

The complication data matter, but need careful interpretation. In a retrospective cohort of 13,653 patients operated on by 202 surgeons at two centres, the association between reports of behaviour and complications persisted after adjustment for selected patient and operation characteristics. Complications affected 10.7% of patients whose surgeons had no previous reports, compared with 14.1% of patients whose surgeons had at least four. These are unadjusted rates for the two extreme groups, not an individual prognosis for a particular doctor’s patient. The study design cannot attribute a specific harm to a specific behaviour or rule out other explanations for the difference. For the director, the findings are a reason to take reports seriously, not a ready-made verdict on the specialist.

How to document the behaviour

Before the conversation, the director needs an account that makes it possible to reconstruct the incident without loaded descriptions. Record the date and setting, who asked the question, how the doctor responded and the immediate consequence for teamwork. If the question concerned a risk, note what clinical information may not have been heard because of the exchange. Separate a witness’s account from assumptions about the surgeon’s intentions and from an entrenched view that ‘they’re always like that’. Then check whether similar incidents have occurred and give the specialist a chance to present their version. Such documentation does not establish their motives; it gives both sides a concrete reference point for the conversation and for assessing change later.

A conversation that ends with an agreement

The conversation should begin with the incident, not a judgement of the doctor’s character. The director might say: ‘At yesterday’s briefing, you interrupted the nurse when she asked about a risk. I expect you to answer every question about patient safety.’ The surgeon’s explanation should then be heard without losing sight of the standard: even a question they consider unnecessary deserves a substantive answer. They should also agree on how the doctor will respond next time they disagree with a team member’s concern. The conversation ends with a review date, for example after the next shift, and a way to gather information about the doctor’s behaviour. This is a proposed approach, not a method whose effectiveness has been established by the cited studies.

Fear of the surgeon leaving: an issue for the director

Fear that the surgeon will leave may keep the director from acting. But it is worth distinguishing a real risk of disrupted services from an untested belief that the specialist cannot be replaced. A practical plan would involve checking the availability of other surgeons, arrangements for handing over patients, opportunities to transfer knowledge and the time needed to prepare another person. This is not about downplaying the doctor’s achievements or pretending that cover is already in place. The aim is to understand the hospital’s constraints so that decisions about standards of teamwork are not driven solely by fear of one person leaving. At the same time, protecting staff who raise concerns should not wait for the conversation with the key specialist to succeed.

How to recognise lasting improvement

After the conversation, counting complaints is not enough. A fall in their number could signal improvement, but it could also mean staff have stopped reporting problems. The director should check that staff can still raise concerns, listen to witnesses across levels of seniority and gather observations from several briefings. Does the surgeon answer questions about risk? Does the team still raise uncertainties with them? How does the doctor respond to critical information? A meta-analysis of 136 samples, involving more than 22,000 people and almost 5,000 groups, found an association between psychological safety and team learning and performance. Many of the included studies were correlational, however, and their levels of analysis varied. Ward observations can therefore help assess change, not prove its effect on patient outcomes.

A surgeon’s track record does not exempt them from answering questions about patient safety. The director needs an account of what happened, a clear standard and a plan to reduce the hospital’s dependence on one person.

Empatyzer in a hospital director’s conversation with an exceptional doctor

Empatyzer can help the hospital director prepare for this conversation without replacing fact-finding about the incident or a decision on the standard of conduct. In the ‘About me’ view, the director considers why they are putting off a meeting with the valued surgeon and how they themselves respond to the surgeon’s authority. Then, in a conversation with Em, they prepare what to say: they describe the interruption during the briefing, its possible effect on the team’s willingness to raise concerns and the expectation of a substantive answer. The ‘You and a specific person’ comparison helps them choose a tone for speaking with this specialist. With Em, the director can separately rehearse acknowledging the surgeon’s clinical achievements and firmly responding to a claim that good results excuse their behaviour. They can also prepare a response to a threat to leave without giving up protection for people who report problems. Finally, they set a date to review the surgeon’s behaviour on subsequent shifts and decide what observations they will need to assess change.