An analysis of closed cases from 2001 to 2010 shows that five per cent of all college cases, and five per cent of all hospital complaints cases, now involve adisruptive behaviora by doctors, according to a new CMPA discussion paper. The majority of the cases, the organization warns, had an aunfavourable outcomea for the doctor. aWhile unprofessional conduct by physicians was never acceptable, it is clearly no longer tolerated in todayas healthcare environment,a the paper states. aIn the long-term, disruptive behaviour can lead to ineffective care, harm to patients and poorer clinical outcomes.a aPhysician disruptive behavioura isnat a one-off, or asingle, egregiousa act, the doctorsa liability insurer says. Rather, itas a enduring pattern of offensive behaviour that poisons morale and potentially harms patients. If a doctor chronically ignores pages, for example, or gets abusive if called at night, nurses and colleagues might be reluctant to report a change in a patientas condition and instead wait for the next doctor to come on duty, delaying treatment. Studies suggest up to six per cent of doctors engage in recurrent disruptive behaviour, says Dr. James Sproule, managing director of physician services at the CMPA. The number is small, but significant, and throws a poor light on the entire profession, he said. Sometimes the offensive behaviour is overt: bullying, yelling and swearing; throwing things and demeaning people in front of others; and uncontrolled outbursts of anger that can leave people feeling constantly on edge. Other times itas more passive-aggressive: not responding to pages or emails; skipping meetings and anot behaving as part of the team,a Sproule said. In one U.S.