ROCHESTER, NY – Results of a new study have been released which describe for the first time the metastatic potential of malignant attendings. “We’ve known for years that these malignancies were locally aggressive,” says lead author Dr. Alan Burgundy. “But we wanted to characterize the later stages of disease, where the malignancy spreads to other health care workers.”
The study looked at fifty attending physicians from a variety of specialties who were identified by their residents as “malignant.” Their malignant behavior was confirmed and quantified by objective criteria, including number of aggressive verbal outbursts, pimping frequency, scut rate, and a measurement of patience relative to the number of patients on service (the patience-to-patients ratio).
Researchers then evaluated how this behavior spread amongst their colleagues. “We investigated regional involvement of residents and medical students on their service, as well as distant spread to other departments,” says Dr. Burgundy. “We saw these malignant characteristics seed to other physicians in proximity, until they themselves became malignant. In some cases, the involvement was so advanced that the metastasis was indistinguishable from the primary site.”
Of note, the patterns of spread varied widely between primary specialty types. Some highly malignant specialties, such as OB-GYN, were extremely locally aggressive with widespread regional involvement, but distant metastasis was rare. Other malignancies, such as cardiology and critical care, seemed to spread through the entire hospital. A particularly aggressive variant of the malignant attending, the malignant charge nurse, commonly presented with stage IV disease, and had an exceptionally poor prognosis.
Now that the disease is characterized, researchers are focusing on treatment options. Unfortunately, in most cases the primary malignancy cannot be removed. In those situations, chemotherapy seems to be an effective palliative option. The most common regimen involves high doses of caffeine three to five times daily, followed by a large bolus of ethanol at night. In attempts to raise awareness of this condition, advocates are promoting July as “Malignant Attending Awareness Month,” though critics point out that early detection does not appear to significantly impact prognosis.