Saturday, November 05, 2005

Are you a disruptive physician?

The phrase “disruptive physician” has been bandied about at medical staff meetings lately. Apparently, most hospital medical staffs have provisions in their bylaws for sanctioning physicians deemed to be disruptive irrespective of their clinical competence. I’ve always been a bit uneasy about this, since any behavior or opinion someone else (such as a nurse or an administrator) finds objectionable could be categorized as disruptive.

Of course there are occasional examples of physician behavior clearly detrimental to patient care such as intoxication, sexual impropriety and threatening or intimidating behavior so severe as to preclude an effective working relationship among staff. Such episodes require an organized, explicit institutional response. The notion of a disruptive physician policy to deal with these situations is sound. But how do you define disruptive behavior? Greg Piche in his Health Care Law Blog recently remarked “The definition of what constitutes disruptive behavior in most of these policies is left so inordinately broad and so diaphanously vague as to render them effective tools for silencing responsible criticism….” His examples of behaviors that could be considered disruptive are concerning; having a disagreeable personality or willingness to speak out against the administration could perhaps result in a disciplinary proceeding.

So this concerns me. Although the original notion of a disruptive physician policy may be valid it could have the unintended consequences of stifling original thought and dissent. This editorial from the Journal of American Physicians and Surgeons warns about abuse of the concept. Please read the whole article, particularly the little ditty at the end.

Disclosure: I have occasionally bumped heads by playing the medical staff curmudgeon role.


Anonymous said...

My husband recently went through something familiar. He is an intervential radiologist in South Carolina. After repeatedly counseling one of the hospital radiology techs about proper technique, a complaint was issued to the hospital about him. The tech said that she felt intimidated and therefore was not comfortable approaching him. In the complaint, she denied any verbal abuse or yelling. My husband was not allowed to know the name of the person who wrote the complaint. The unsubstantiated complaint resulted in my husband having to be evaluated by a hospital appointed psychiatrist (who, by the way found nothing wrong with him and wrote a letter in support of him). Needless to say, he has since chosen to work elsewhere, but he now is legally required to reveal that he was evaluated for "disruptive behavior" on all licensing, staff and managed care applications. So much for due process.

geenavee said...

What ever happened to the chain of command? If I felt that I had to repeatedly counsel someone about a technique in a job standard, I would after one or two attempts go to that persons superior, evidently my communication skill is not up to par, or my evaluation of the technique is skewed. Constant complaining is a problem, whether we choose to recognize it or not, perhaps there is some underlying issue that needs to be addressed.

Anonymous said...

As a long term caregiver for a disabled relative who received care at a teaching hospital, I fully support thoughtful reporting and evaluation of difficult physician behaviors. I have seen my relative bullied for expressing emotion/pain during exacerbations of his illness. I have witnessed physician dismissal of new symptoms and the devastating medication complications resulting from such dismissals. I have observed a lack of respect for my relative's treatment choices and seen outright denial of referral for palliative procedures as well as denial of referral for second opinions.

I have worked hard over the years to advocate for my relative, sometimes successfully -- but seldom without an argument. All the while I felt trapped because the physician in question was the only local specialist with the credentials to treat this particular illness.

In my experience, these bad behaviors do not occur in a vacuum. I witnessed verbal abuse of several residents under this doctor's supervision. As a first degree relative of a challenging patient, I felt that filing a complaint was an ethical quandry because, afterall, I was not his patient. I sometimes wonder if this doctor would have an epipany if able to see these actions played back on a video monitor. In every other respect, this physician was very talented.