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Disruptive physicians: Don't let the bullies win

Medical Staff Leader Connection, June 12, 2003

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Dear Medical Staff Leader,

Physician leaders most often cite disruptive physicians as their top challenge. In fact, the number of complaints from physician leaders and hospital administrators about disruptive physicians could convince you that the health care industry is undergoing an epidemic of disruptive physician behavior.

But is this truly an epidemic? The Greeley Company has found that most often it is only one or a few physicians at the hospital who creates a negative and demeaning image that often affects how the rest of the medical staff is perceived. Why do physicians allow this to continue? Disruptive physicians threaten nursing recruitment and retention at a time when many hospitals can't afford to lose a single nurse, and it undermines respect for the medical profession. In addition, this behavior demonstrates the organized medical staff's inability "to police its own"--leading to snickers about how well physicians hold one other accountable in peer review.

However, allowing a physician to continue his or her behavior because they are a "heavy hitter" or a "big admitter" may be the most damaging move. If we are afraid to confront a disruptive physician about behavior we would not tolerate in any other professional setting because we are afraid he or she will take his or her business across town, we are succumbing to the threats of a bully. Nobody likes to be pushed around by a bully. Yet no physician will stand up to a bully if they know the chief executive officer (CEO) and the board will back down at the threat of losing substantial business. When this happens, other physicians will roll their eyes or make disparaging remarks about how the CEO or the board only worries about the "holy dollar." It leaves physician leaders frustrated and demoralized, and negatively affects the relationship between the medical staff, administration, and the board.

Hospitals face daunting financial realities that force administrators to make difficult choices. However, we are in the midst of a dramatic change that is redefining acceptable physician behavior. Behavior that was tolerated in the past will no longer be tolerated. And like most bullies, when this happens they usually back down. It is rare that a physician actually follows through with a threat to pull patients out of a hospital solely because they are called to account for their disruptive behavior.

So do your homework as a physician leader and ensure you have a clear physician behavior policy or other clearly articulated expectations. Warn physicians that you will enforce these expectations, and work closely with your CEO and board to anticipate any potential threats about pulling patients "across town." If a physician makes such a threat, everyone should be prepared to say in response, "Don't let the door hit you in the rear." Once you have the full support of the CEO and the board, you can stand up to the bully. If you do this clearly, professionally, and collegially, the medical staff will stand up and cheer because nobody likes a bully.

That's all for this week.

All the best,

Rick Sheff, MD

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