Wednesday, September 30, 2009

Disruptive physicians

Despite the fact that Joint Commission’s disruptive behavior standards now apply equally across all disciplines in the health care environment, in common usage the discussions usually focus on doctors. Even more so these days the attention seems to be shifting to hospitalists. As Bob Wachter noted in a recent blog post, hospitalists are now expected to be the “best behaved doctors in the building.” In part this is because, as Bob pointed out, hospitalists’ and hospitals’ incentives and accountabilities are aligned, like never before. Or so we would hope.

I’m thinking back to my pre-hospitalist days of traditional internal medicine practice. My medical group was one entity and the hospital was another. My accountability was to meet the requirements of medical staff membership. That was it. On a couple of occasions I and some of my colleagues did battle with the hospital. Back then we believed we were just advocating for better patient care, but things have since changed. I wonder if some of those actions would now be considered disruptive behavior.

How well aligned are those incentives, really? Every day I see competing agendas between the hospital and physicians, and within the hospital. These tensions can range from healthy to counterproductive. As hospitalists, the hospital is now one of the patients we must treat. That being said, our most important patients are the human beings that occupy the beds. The best I can do as a hospitalist is to advocate for those individual patients above all else. Occasionally that will conflict with the business incentives of the hospital. Will I be perceived as disruptive?

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