Disruptive behaviour among physicians; a few bad apples or the whole barrel?

I am reviewing the literature on disruptive behaviour among physicians, and the Leape et al (2012) article stands out as one worth reading [Acad Med. 2012;87:845–852. doi: 10.1097/ACM.0b013e318258338d]

Some of their conclusions are worth repeating;
"We believe, however, that the fundamental cause of our slow progress is not lack of know-how or resources but a dysfunctional culture that resists change. Central to this culture is a physician ethos that favors individual privilege and autonomy—values that can lead to disrespectful behavior."

"Students and residents suffer from disrespectful treatment. “Education by humiliation” has long been a tradition in medical education and still persists."

While other authors in the field are a bit too focused on repeat offenders (which is a worthy topic), Leape et al provide a cogent series of arguments that should force us to look at the system issues that contribute doc's behaving badly.

The implications for patient safety come screaming out at us......