Define physician disruptive behavior

Residency Program Insider, March 22, 2005

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Dear residency program colleague:

Disruptive physician is an ever-present challenge that can begin when the physician is still in his or her residency. To help tackle this troubling issue, residency programs must contribute to the development of a systematic approach to eliminating such behavior.

The first step in this process is defining what constitutes disruptive behavior. Such a definition is essential when a disruptive physician launches into a long and impassioned argument about why their behavior is not disruptive. The physician will likely retort with some variation of the following:

  • What is so disruptive about advocating for my patient to get good care? That's the least I owe to my patient.
  • This is the only way anything changes. It's the squeaky wheel that gets the grease around here.
  • That nurse was so incompetent, she was going to kill my patient.
  • What do you expect me to do, turn my back and let it happen?
  • Somebody's got to have the spine to stand up for what's right.

In other words, problem physicians may assert that disruptive behavior is in the eye of the beholder. Therefore, to define disruptive behavior, start with the dictionary for clarification of what exactly the term means. When you do so, you'll find words like troublesome, troublemaking, unruly, disorderly, upsetting, disturbing, and distracting.

Do these descriptions apply to disruptive behavior in your organization? You bet. Physicians do not have a right to act in a manner that brings these words to mind because those who do so "disrupt" hospital operations. Such behavior adversely affects the ability of others in the hospital to do their jobs, creates a hostile work environment for hospital employees and the medical staff, and lowers the community's confidence in the hospital's ability to provide quality patient care.

The starting point for eliminating disruptive physician behavior is to define the behavior in a policy. You can begin positively by stating the goal of your policy. For example,

It is the policy of this hospital to treat all individuals within its facilities with courtesy, respect, and dignity. To that end, the board requires that all individuals, employees, physicians, and other independent practitioners conduct themselves in a professional and cooperative manner in the hospital.

After establishing the goal of positive behavior, it is important that the policy define with some specificity what constitutes disruptive behavior and the behaviors that violate the policy. Do not be overly specific; it could limit you. Instead, include a description of how a physician's behavior can disrupt the operations of the organization. The list will be similar to the potential adverse outcomes identified above. You may also want to provide residents with examples of unacceptable behavior that would violate the hospital's policy, including

  • personal, irrelevant attacks-verbal or physical-leveled at other residents, medical staff members, hospital personnel, and patients and their families
  • impertinent and inappropriate comments (or illustrations) made in patient medical records or other official documents that impugn the quality of care in the hospital or attack particular physicians, nurses, patients, or hospital policies
  • criticism leveled at the recipient in such a way that it intimidates, undermines confidence, belittles, or implied stupidity or incompetence

That's all for this week!

All the best,

Rick Sheff, MD

Chair and Executive Director

The Greeley Company


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