The investigators surveyed nearly 250 providers of perioperative care (eg, physicians, nurses, anesthetists, and others) at a single academic medical center to study the negative impact of disruptive behavior. The authors report that the stated behaviors affected communication, teamwork, staff relationships, and also the perception of threats to patient safety and quality of care. The authors conclude that organizations must acknowledge the presence and effect of disruptive behaviors and institute policies and processes to address the issue. A past survey study by the same authors examined the impact of work relationships on clinical outcomes. Dr. Lucian Leape also discussed the issue of problem doctors and disruptive behavior from a systems standpoint.