There should also be training in documentation of the unacceptable behaviors. This should include:

• Time and place of the occurrence.
• Detailed factual description of the behavior.
• Circumstances that precipitated the behavior.
• List of others who observed the incident.
• Consequences this behavior had on patient care and hospital operations.

This documentation is vital. Unlike medical mishaps that are usually well documented, these incidents may be poorly recorded and it is often the collection of multiple reports from many observers that eventually become grounds for remedial action.

Reporting incidents is most difficult because:

• It may have a marked impact on the physician’s career.
• It needs to be understood that reporters will be protected.
• The hospital itself may be reticent to interfere because of a desire to avoid unpleasant, possible litigious, confrontation. There also may be economic reasons - the physician may be a high volume admitter or the only practitioner of his/her specialty.