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.

Switching Psych Meds Often Doesn’t Help

December 19, 2016

medication changeA recently published meta-analysis of over 3000 studies suggested that switching antidepressants after the first drug doesn’t produce the desired results is not better than staying the course and/or exploring options other than trying a different drug.  This is a very interesting finding as most prescribing clinicians tend to give one antidepressant a “trial” of about 6-12 weeks.  If things aren’t better then often scrap that medication and start another 6-12 week trial of another one.  The authors of this article reviewed 3234 relevant studies and concluded that it is generally wiser to explore alternatives other than a medication change.

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.

Primary Care Providers to Screen all Patients for Depression

January 27, 2016

The US Preventive Services Task Force (USPSTF) now officially recommends that primary care health clinicians screen all of their patients for depression. Though this is wonderful, this is very, very long overdue. The costs associated with depression and other mental health screen are insignificant relative to the potential gains of “catching” otherwise unrecognized suffering patients. Physicians and other front-line, primary care providers are offered screening guidelines by the AMA via this JAMA article.

Hopefully with more patients being routinely screened, including pregnant and post-partum women – – an often overlooked depressed population, more people will receive quality treatment consisting of psychotherapy and/or antidepressant medications.

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.”

Scarcity of Time

January 2, 2014

timeI often hear from my patients how busy they, their careers and their lives are.  Occasionally, their impatient, abrupt or frankly disruptive behaviors at home or at work are blamed upon simply not having the time to slow down to deal with others more gently or explain things more patiently.  In their haste they find themselves bogged down by having to deal with others’ hurt feelings, confusion or seeming incompetence; this, of course, only makes matters worse as they then have to apologize, remediate the situation or reexplain things, all in the context of the limited resource of time.

On the way into work this morning, I heard a great piece on NPR about “scarcity.”  The piece compared how poor people often mismanage money (e.g., buying lottery tickets, renting large tv’s, etc) to how busy people often mismanage time.  Both groups of people have trouble managing their limited resource.  I found this fascinating and directly relevant to many of my patients.  I do a lot of psychotherapy and remedial coaching with physicians, other healthcare professionals and executives, and I find that nearly all of them are truly quite busy and they work very demanding schedules.  But it never ceases to amaze me how so many of these brilliant people struggle to appreciate the need to devote time to their interactions with other people.  I’m not a huge fan of Steve Covey’s “7 Habits” but I love the one where he says, “with people, fast is slow and slow is fast.”  You can’t rush relationships.  You can’t speed up communications beyond a certain threshold.  Instead we need to devote sufficient time to our interpersonal relationships, to nurturing them and communicating effectively within them.

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.

Physician Burnout

June 10, 2013

I just came across a recent article in the AMA’s newsletter,, about physician (and staff) burnout.  Nothing all that new here, but it talks about how overwork and burnout of one member of the treatment team or office staff – – physician or non-physician – – affects the productivity, engagement and satisfaction of others in the office.  Many of the physicians and other healthcare workers who come to see me for therapy or coaching suffer from burnout.  This tends to be particularly troubling for those professionals who are highly specialized in their training and expertise as they often feel that there are no other options but to continue in their current mode of practice, leaving them to feel trapped.  Burnout is relatively easily dealt with once the problem is identified and the professional invests her/his attention and time to the matter of resolving the situation.

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