By Thomas A. Lerner
Every organization is at risk arising from disruptive behaviors by its key employees. For healthcare organizations, the risk is most acute when the disruptive behavior is by a physician, but misconduct by healthcare providers is not limited to physicians alone.
Disruptive behavior by healthcare providers increases patient risks, undermines the mission and reputation of the practice or institution where the behavior occurs, impairs morale, causes staff turnover, and may lead to employment litigation.
Managing a disruptive physician is as critical as it is exhausting, and can lead to direct and indirect financial consequences. This article addresses how some of those behaviors manifest themselves, the potential legal and financial consequences arising from a failure to address the conduct, and considerations of a tiered response to disruptive behavior.
"Disruptive physician behavior" is commonly thought of as referring to the loud and aggressive practitioner, who may engage in threats, intimidation, abusive language and demeaning behavior toward other staff and physicians.1 The behavior may manifest itself in direct interactions or even in chart notes sniping at the decisions or conduct of another provider. The loud and aggressive practitioner may demand more perquisites, viewing this as his due in light of the unique value which he believes he brings to the practice.2 At the same time, he may balk at taking on responsibilities that benefit the group as a whole, but which do not translate into income for himself.
Disruptive behavior can also take a more passive form. A hyper-cautious physician may become a burden on practice resources, and in a group practice can impair smooth and equitable sharing of call responsibilities. The passive physician who overly narrows the scope of his practice, shies away from call responsibilities or otherwise demands special scheduling consideration can also be a disruptive force in a group practice. Whereas the loud and aggressive practitioner carries the unpredictability and explosive force of a volcano, the "passive" practitioner causes continuing wear, like sand in the gears.
Each presents his own complicating traits for patient care. Staff and other physicians may avoid these practitioners, because the toll the interactions take feels too great. As a result, important communications regarding patient care may be missed. After all, it is hard to listen attentively when one feels at risk of being subjected to abusive behavior.
Similarly, the intensely impatient practitioner is less likely to carefully and comprehensively communicate his instructions, thereby increasing patient risk, while the more "passive" practitioner may simply become unavailable to provide timely and complete responses. A physician who fails to timely complete records or respond to pages places patient safety at risk.
The presence of a disruptive physician of any stripe makes the workplace less hospitable. This leads to dissatisfaction and dissension among colleagues who already are struggling to navigate their practices through a continually evolving medico-legal environment. Staff morale will be impaired, with the likelihood of higher staff turnover. The disruptive conduct could spawn the assertion of legal claims by current or departing employees, including claims that may not be covered by insurance.3
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