Article: Disruptive Physician Behavior

March 7, 2018

A colleaguedisruptive professional, anger management, bully, abusive boss from the University of Maryland/VAMC, Preeti John, MD, and I just published an article in the Journal of Hospital Medicine about disruptive physician behavior.

Check it out:

Disruptive Physician Behavior: The Importance of Recognition and Intervention and Its Impact on Patient Safety

And please read more about my work with disruptive physicians, healthcare workers and other professionals.

When Patients Try to Seduce Doctors

October 31, 2016

I was recently interviewed for a Medscape article about maintaining professional boundaries, entitled, When Patients Try to Seduce Doctors.  It’s a relatively short piece and, though I was misquoted a little, it has some good information about the doctor-patient relationship and the importance of establishing and upholding appropriate professional boundaries.  Check it out.

Disruptive behavior linked with safety problems

October 8, 2015

The Washington Post ran an article about a Tel Aviv University study of the effects of physicians’ disruptive behavior on patient safety.  As discussed in previous posts, there is a clear link between disruptive behavior among physicians (and other professionals) and negative patient outcomes.  The coworkers who are often the target of or witness to disruptive behaviors typically avoid their disruptive colleague.  This avoidance is understandable but can significantly break down communications among treatment teams.  When the different members and disciplines within a treatment team do not candidly interact with each other bad things happen: nurses don’t confront physicians’ mistakes, wrong-sided surgeries occur, etc.  Disruptive behavior must be taken seriously and assertively addressed by leadership.

Does empathy matter

March 13, 2015

As a psychologist, this is no surprise to me, but medical schools and physicians’ residency training programs are concluding that empathy (understanding the patient’s perspective and effectively communicating that understanding to him or her), in fact, matters quite a bit.

Programs Aimed At Equipping Doctors With Empathy See Yielding Results.

In a nearly 1,650-word piece, Kaiser Health News Share to FacebookShare to Twitter (3/13) reports efforts to teach doctors about empathy is yielding results, citing the example of a Jeremy Force, a first-year oncology fellow at Duke University Medical Center. Force put into practice what he learned in “‘Oncotalk,’ a course required of Duke’s oncology fellows,” consequently earning praise from a patient suffering from breast cancer. The article notes “clinical empathy was once dismissively known as ‘good bedside manner’ and traditionally regarded as far less important than technical acumen.” However, “a spate of studies in the past decade” has come to the conclusion that “it is no mere frill,” and empathy “is considered essential to establishing trust, the foundation of a good doctor-patient relationship.”

Review of a tutorial approach with disruptive physicians

September 24, 2013

My friend and colleague, Mike Plaut, has another paper out (actually it’s still in press) in the Journal of Health Care Law and Policy.  Mike’s writing is great – almost conversational – so I always enjoy reading his stuff.  In this paper he describes the work he’s been doing for years at the University of Maryland’s Medical School with health care professionals who act out sexually with patients.  Similar to the work I do with disruptive professionals, Mike works individually with physicians and other providers rather than working with groups, and he tailors his interventions to the individual.  Now, in contrast to most of my work, Mike holds tighter to the role of the academic advisor than therapist or even coach, as he guides the professional through the relevant literature and has them write a paper about the reason for their referral to him.  I typically blur the boundary between coach and therapist as I believe there are more similarities between remedial coaching and psychotherapy than differences, and I have found this to be an invaluable approach to my work with physicians, psychologists, nurses, other healthcare providers and other professionals who have gotten themselves into hot water at work, usually because of interpersonal problems.

Physician Fitness for Duty Evaluations

September 19, 2013

I just found an interesting article that is still in-press about fitness for duty evaluations for physicians.  A significant part of my practice is devoted to assessing and addressing issues related to physician (and other professional) impairment and disruptive behavior.  Much of the consulting I do is with licensing boards, professional associations, hospitals and practices, so this article was of great relevance to my practice.  One of the findings that I was particularly pleased to read was that the authors noted that of the physicians they evaluated, most of the time those referred for “disruptive” behavior were assessed as being fit for duty.  This is consistent with the majority of my findings; however, this should not be misinterpreted as saying that there are not very significant potential risks and dangers of disruptive conduct within the workplace.  In fact, this is precisely what makes it so difficult to perform fitness for duty evaluations for disruptive professionals: though such healthcare providers may not be impaired personally, the effects of their behaviors may (and often do) negatively affect the safety and efficacy of their colleagues performance.  So while the disruptive physician may be assessed as being fit, her disruptive behavior may still pose significant problems to the overall functioning of the work environment including compromising patient safety.

Doctors Lie?

March 29, 2012

There was a very nice, honest piece in the Op-Ed section of the NYT recently about doctors’ feelings and why they lie (or don’t tell the whole truth) to their patients.  The physician/author candidly shared some very personal feelings and stories about when she wasn’t able to tell her patients the truth and when she actually lied to them.

Many physicians (and the attorneys who counsel them) believe that if they give bad news or, even worse, if they admit to committing a medical error, they will be the subject of a malpractice law suit.  Interestingly, however, the data suggests otherwise: patients rarely sue doctors who they like and who are honest with them.  Think about it: its no surprise that patients are more likely to sue their doctor when they find out that the doctor messed up and covered up something while caring for them.  In contrast, when someone frankly and honestly apologizes to you for making a human error, you are far more likely to forgive them.

Perhaps honesty really is the best policy.

Changing definitions

November 23, 2011

On November 9, 2011, the Joint Commission announced that they will be changing the definition of the term “disruptive behavior.”  Specifically, they have noted that disruptive behavior is “behavior or behaviors that undermine a culture of safety.”  They added that term is not viewed favorably by some and that many find it to be ambiguous.  Though I surely agree with this, I do not foresee an large, wide-reaching entity such as the Joint Commission being able to define a very complex range of behaviors in a way that covers all it needs to cover without going too far.  When I give talks about disruptive behavior and workplace violence I often suggest that (unfortunately) the classification of one’s behavior as being disruptive “lies in the eyes of the beholder.”  There’s no way the Joint Commission (or even a hospital, small practice or company) could get away with that.

Dealing with Disruptive Physicians

August 16, 2011

Here is a nice audio presentation about dealing with disruptive physicians entitled, “Empowering Physicians to Overcome Disruptive Behavior.”  I would have liked for Marty to have commented about what resources are available for people who are confronting disruptive behavior.  For example, most hospitals has employee assistance programs, in Maryland administrators can seek guidance from Med Chi, the State’s Medical Society, and of course there are independent consultants like myself who specialize in helping organizations deal with disruptive behavior and help coach the disruptive professional toward more appropriate and productive behavior.

Cause and Effect

May 26, 2011

I just watched an interesting presentation by the American College of Physician Executives on the Causes and Effects of Disruptive Behaviors.  It was a nice, short presentation that addressed the prevalence and the impact of disruptive behavior among physicians.  Interestingly, in their study, 99% of the individuals surveyed reported patient-safety implications secondary to a doctor’s disruptive behavior.

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