Overtly disruptive behavior by physicians is disturbingly common and can have profound negative effects on other health care workers. This two-part commentary by safety expert Dr. Lucian Leape issues a challenge to health care organizations to eliminate disruptive behavior, identifying it as a symptom of a pervasive culture of disrespect in health care. The first part of the commentary identifies six types of disrespectful behavior, ranging from outright abuse to more subtle forms such as opposing quality improvement efforts, and explores the role health care system factors play in fostering such behavior. The second part discusses the role a culture of respect plays in developing high-reliability organizations and identifies specific strategies organizations can use to address disruptive and disrespectful behaviors. The chilling effect of disrespectful behavior, and how an organization responded, is discussed in an AHRQ WebM&M commentary.