Physicians, other health care workers with Intermittent Explosive Disorder, Alcohol Overuse, and Guns, an under-reported, under-recognized component to the relatively poor level of Health Care in USA

Intermittent Explosive Disorder (IED) is a psychiatric entity with an ICD 10 code that refers to individuals who express sudden bouts of rage too extreme for the situation. I have termed this Hostile Personality Disorder. Jeffrey Swanson, PhD faculty in Psychiatry at Duke reported a study that 9% of adults, almost all males, had anger issues and access to guns. This study was published in 2015. One would have to estimate based on the political climate since 2016, and escalated through to today, that number may be as high as 30% currently.

The problem with physicians who show this anger dysfunction at work and are known to have an extensive gun collection, there is extreme reticence on the part of all healthcare workers in their sphere to speak out about any combination of their rage, their alcohol use at work, or their incompetence. This includes the chair of the department. The end result is the high probability of poor health care delivery to patients. This is a contributory to the overall relatively poor performance of health care in the US, ranked 16 th in quality among nations, despite spending much more than any other nation on health care. The explanation for silence, and the permission of poor health care delivery is quite simple: no one wants to be shot and killed. The incompetence extends beyond just the physician, but all other aspects of heath care touched on by his involvement, which can be broad and deep.

There is no simple solution to this problem. The starting point though is the recognition that this a big problem, getting worse, and something must be done about it. Male physicians with Hostile Personality Disorder (AKA: IED), alcohol over use, and huge gun collections. This is a subject that I have considerable personal and professional interest and knowledge about.

Richard Semelka, MD