Monday, July 27, 2015

The problem doctor--unpleasant behavior does happen

Most people working in healthcare probably have encountered a "problem" or "disruptive" doctor. Physician antisocial behavior takes many forms, ranging from the petty and silly to the dangerous and criminal. Temper tantrums, demeaning attitudes toward staff and patients, and a refusal to abide by the practice's or hospital's policies are all too common.

"I've seen everything—doctors striking patients, destroying hospital property, stalking nurses, surfing the Web for porn while at the hospital, shouting profanities at staffers, you name it," says Will Latham, a practice management consultant in Charlotte, North Carolina.

The problem of "problem" doctors is more extensive than many realize and has a far-reaching impact on patient safety, staff retention, a group's or hospital's malpractice liability risk, and the organization's financial bottom line.

More than 70% of physicians say that disruptive physician behavior occurs at least once a month at their organizations, and more than 10% say that such incidents occur every day, according to a 2011 study of more than 840 physicians and physician leaders from QuantiaMD and the American College of Physician Executives.  One half of the respondents reported that they know patients have left their practices because of disruptive physician behavior.

"You can put up with only so much abusive behavior before it crushes your spirit," says Ken Hekman, a practice management consultant in Holland, Michigan. "Some employees and patients will start voting with their feet and just quit. Patients are more likely to find another doctor rather than report the problem to the practice administrator."

In 2008, the Joint Commission for Accreditation of Healthcare Organizations started requiring hospitals to confront disruptive medical staff members, implement a code of conduct, and provide education to address the behavior. That new requirement has made hospitals far less tolerant of doctors who act out by throwing instruments or abusing staff...

"A really good surgeon who was well liked was persistently late in doing his charts," says MGMA's Dr Fischer-Wright. "The group even hired a consultant to work with him, because the practice was losing more than $20,000 a month owing to his incomplete charting. Finally, there was a seminal event. The surgeon knew that a patient had an allergy to a medicine but never charted it. So a colleague who was on call prescribed that medication. The patient ended up on a ventilator for 3 days in the intensive care unit owing to an allergic reaction. Then the group finally insisted that the surgeon complete his charting or be dismissed."

Other practices deal with late charting and similar issues by hitting doctors where it hurts—in their pocketbook. "Some practices have 'good citizenship' pools where each doctor deposits several thousand dollars per quarter," says Judy Aburmishan. "The rules may say that charts have to be turned in within 5 days. At the end of the year, the group splits the pool based on how doctors comply with various rules. Late charters are penalized financially."...

Many times, a disagreeable doctor is suffering from burnout and it shows in his work, says Dr Fischer-Wright. "These doctors are slightly disengaged, sometimes belligerent. They don't take good histories or encourage patient questions. Group leaders need to approach the doctor in a collegial way, saying such things as, 'We're a little concerned because you seem unhappy. Do you need some help? Do you need time off?' This gives the doctor some options, and he doesn't feel like he's being attacked."

If the problem remains unresolved, the next step might be a more formally documented conversation, in the presence of the practice administrator and senior partners. The group's leaders can outline an improvement plan, perhaps recommending or requiring anger management classes. "If that doesn't work," Hekman says, "the group has to be more serious, telling the doctor that he may need to take some time off to think about the issue and that he may ultimately be terminated if the behavior doesn't improve."...

Many times, someone who's distracted or disruptive may only be acting that way because he or she is having personal problems that you may be in a unique position to see and help address. So don't be quick to dismiss or otherwise penalize someone who's talented and an asset to the practice. Find out what's really going on. But if the bad behavior is unrelated to a particular situation that could be solved, or a disruptive physician doesn't shape up, patient safety and the integrity of the practice are more important than one physician's hurt feelings.

1 comment:

  1. "The definition of 'disruptive physician' is so broad that virtually all physicians fit the profile, leading to a gross increase in sham peer-review cases at many hospitals," a cardiologist asserted. "The small percentage of doctors who are truly disruptive can be referred for mental health evaluation and their careers saved. Early intervention is important."

    "Labeling a physician 'disruptive' is now the number-one weapon for driving out physicians who may compete monetarily or who themselves question the conduct or professionalism of an organization or entrenched or senior individual," a geriatrician contended. "Such labeling may also be used to carry out vendettas for obscure motivation."

    "The notion of 'disruptive physician' is a label used to threaten and intimidate physicians who don't agree with whatever hospital administrators and nurse managers want to impose on us," a pain management specialist observed. "This is part of a power grab that must be resisted for the sake of our autonomy. Of course, you are by definition disruptive if you speak out against these things."

    "Evaluation of disruptive behavior is a form of professional peer review," an emergency physician agreed. "Such activity has to be performed on a level playing field, and all physicians should be held to the same ethical standards for performance. Disruptive behavior by a physician who generates high revenue for a hospital generally gets a pass, even for such activities as sexual harassment, sexual assault, or drug abuse, because of corporate concerns over financial losses or bad publicity. On the other hand, physicians who treat complex and high-risk patients may not be as cost-efficient and are frequently targeted by insurance carriers or hospitals for exclusion."

    For some commenters, being branded "disruptive" wasn't necessarily a bad thing. "Disruptive behavior is positive," a pulmonologist argued. "Question the norm," he urged. "If you can't accept and learn from the unusual, then you should examine your own professional philosophy. Many doctors have disabling personalities. It goes with intelligence."