Anger Management Goes to the Doctor
In an operating room at a large regional hospital, George Anderson opted to sit on a low metal stool. He had no interest in the patient undergoing open-heart surgery. Instead, he positioned himself to have a good angle on the surgeon’s face. Asked by the hospital to help the cardiac specialist curb his explosive tantrums, Anderson, an anger management expert, watched carefully for signs of irritation. For a while, the surgeon worked steadily, but then, just as he sewed a valve into the patient’s heart, his phone buzzed. He took the call. Not a friendly one, evidently. He cursed and screamed into his hands-free headset for about a minute before abruptly hanging up. No one uttered a word. “Everyone in the room was stunned,” says Anderson, 73, in his soothing Mississippi accent.
In an earlier blowup, the doctor had torn into an anesthesiologist and attorneys were calling—even while he was in the OR. (Because of confidentiality rules, Anderson will only identify the doctor as one of the “top bypass surgeons” in the country.) If the surgeon couldn’t keep his rage in check, he would lose his job and the hospital would possibly be penalized, to say nothing of the patients under his scalpel. After the operation, the surgeon took off his latex gloves, threw them on the floor, and left the operating room in silence.
Anderson & Anderson, the business Anderson founded 30 years ago in Los Angeles, has trained and certified at least 11,000 anger management specialists. Lockheed Martin, Halliburton, and United Parcel Service have used his services to ward off lawsuits and dust-ups, as has the federal prison system. He was even tapped to consult on Anger Management, the 2003 Adam Sandler/Jack Nicholson comedy.
Over his career, Anderson has had clients from a variety of industries, including athletes, cops, and business executives (though as yet no JetBlue flight attendants). Last year, for the first time, more than a third of his income came from medical workers; this year he expects to add 125 more of them, sent to him because of their inability to manage the pressures of the job. Asks Anderson: “Can you imagine the amount of stress a doctor experiences just by waking up in the morning?”
Medical professionals present Anderson with unique challenges. Their hours are brutal, the stakes are high, and the threat of malpractice suits is ever-present. The life-or-death nature of the work wears at steely nerves even on the best days, Anderson says. Many doctors work long hours at the expense of family and exercise, which can dissolve tension. One doctor laughed in his face when he suggested she take a vacation. There’s another factor to consider: Since 2010, doctors’ pay has stagnated, with some specialties weathering a 10 percent cut.
Anderson was among the first of his peers to capitalize on the boom of rageaholic caregivers. It began in earnest in 2009 when the Joint Commission, an independent body that is the largest accreditor of medical programs, mandated that hospitals deal with “disruptive” docs. In one study, published in American Journal of Nursing in 2002, 90 percent of hospital workers, including doctors and nurses, reported “yelling” and “abusive language,” along with “condescension” and “berating colleagues.” A quarter of the 1,200 people in that survey said they witnessed such behavior weekly. “There isn’t a doctor alive who hasn’t seen it,” says William Norcross, executive director of a program at the University of California at San Diego that uses anger management to treat irascible physicians.
According to Anderson, verbal abuse is among the milder transgressions. “Throwing instruments, like scalpels, is not unusual,” he says. One surgeon flung a tool after being handed the wrong item twice. It struck the ceiling. Another launched a used instrument, hitting a nurse on the shoulder.
In this still-young discipline, approaches to treating hotheads vary. The term “anger management” was coined in 1975 by psychologist Raymond Novaco. Anderson, who studied psychotherapy at Harvard Medical School, first wrote his own curriculum in the mid-1990s to treat offenders adjudicated by Los Angeles County courts. Demand grew after September 11, longtime providers say. That boosted the number of businesses and individuals certified to offer anger management by U.S. companies to more than 17,000. It is now standard practice to advertise courses, as Anderson does, tailored to the specific temperaments of various professions. Courses meant for businesspeople are often innocuously billed as “executive coaching” because of the corporate desire for anonymity—a characteristic shared with the medical Establishment. “Physicians are … paranoid to have anyone knowing that they received psychotherapy,” Anderson says.
To teach patients to defuse a blowup, Anderson has them practice long, slow breaths through their noses and think the word “peace” on inhalation and “release” on exhalation. In addition, he coaches people to lie down, take a time out, and imagine being on a beautiful beach. Or to replace inner dialogue like “I’m such an idiot” or “what a jerk he is!” with a positive statement, such as “someday we will laugh about this.”
Anderson saw a spike in doctor clients this year after signing a contract with Kaiser Permanente, the California-based managed-care organization that provides health services to almost 9 million people. For some on-site courses, Anderson charges upward of $8,000 a pop; in his Wilshire Boulevard office in Los Angeles, it’s $5,000. In most cases, hospitals will happily pay to make the rage go away. But “if they want to punish the doctor, they make him pay,” he says.
Typically, doctors meet with Anderson face-to-face for a total of six hours. After that, they talk on the phone with him twice a month for six months. At the beginning and end of that time, the doctor takes a test on “emotional self-awareness.” He rates himself on a scale from “never” to “always” in response to statements such as “It’s hard for me to smile” and “I care about other people’s feelings.” Once problem physicians see how low they score on these tests, Anderson says, they surrender to the process. This stands in contrast with business executives; they tend to resist and ask for further evidence that Anderson’s services are really required.
The first thing Anderson tells doctors is that high intelligence is no protection from stupid behavior. It cannot prevent the flubbing of jobs, marriages, or relationships. Meanwhile, Anderson’s workbook, The Practice of Control, which he has adapted specifically for doctors, teaches them that anger is as injurious as “smoking a pack of cigarettes each day.”
Based on follow-up calls with hospitals, Anderson says that four-fifths of his doctors have curbed their workplace explosions. Doctors are motivated to rescue their imperiled careers and love lives, he says. “I can’t imagine any other population of clients that does as well.” But there is one profession with whom Anderson does civility training that tests his own composure. “Lawyers,” Anderson says with simmering indignation, “I do not like at all.”