Disruptive Doctor Can Be Toxic

March 24, 2008

75%

--Percentage of US healthcare workers who say disruptive behavior reduces patient satisfaction and care.

(Jointcommission.org, 2008)

We all have a bad day now and then, but what happens when a physician’s bad mood is more than just an occasional occurrence? Physicians who consistently demonstrate negative behavior can become a disruption to the healthcare environment and ultimately can have an adverse effect on patient care. And, if this disruptive behavior is happening in your medical office or hospital, it could be affecting you financially.

Identify a Toxic Doctor

The American Medical Association Code of Medical Ethics defines disruptive [physician] behavior as "personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care." These behaviors can include gossip, yelling, foul language, insults, disrespect of colleagues and/or patients, inappropriate touching, and refusal to complete tasks. Most commonly, these behaviors involve conflicts with nurses and other staff. A physician who is exhibiting disruptive behavior may be experiencing severe stress due to work or home situations, or problems with substance abuse, fatigue, a medical illness, or a psychiatric disorder.

A Physician Executive a few years back found that 96% of doctors reported dealing with disruptive physician behavior and 70% said that such behavior nearly always involved the same physician. An American Journal of Nurses survey indicated that 86% of nurses had witnessed disruptive physician behavior; other studies have shown that more than 90% of nurses have experienced verbal abuse by physicians.

Financial Effects The conflicts that can result from a disgruntled practitioner affect staff morale, diminish productivity, and cause work-related stress. Such an environment can lead to high staff turnover, which could result in a lack of patient—staff bonding and trust. Nurses or other physicians may avoid a disruptive doctor or may hesitate to make suggestions about patient care. Also, a physician's judgment may be impaired if their focus is on either avoiding conflict or creating conflict. High turnover, decreased morale, and an unfocused staff can limit a practice's future potential, increase burnout, and may lead to increased malpractice risk.

The doctor—patient relationship suffers as well. Paul S. Mueller, MD, MPH, a member of the ACP Ethics, Professionalism and Human Rights Committee, expresses how a physician’s relationship with a patient can be negatively affected by a referral resulting in a bad experience. “A patient may inquire why the referring physician sent the patient to the disruptive physician in the first place.” An organization that employs a disruptive doctor may also be perceived negatively. “Experience suggests that patients may develop negative views of a healthcare organization based on encounters with a disruptive physician and choose to go elsewhere. The organization may be viewed negatively because it allows a disruptive physician to work there,” Dr. Mueller explains.

Your Patients & Practice How can you protect your practice from the fallout of a disruptive physician? First, identify potential conflicts by regularly speaking with colleagues and staff, and address concerns immediately. Read through patient complaints, patient surveys, and peer reviews. Establish who's in charge of the practice and clarify expectations.

Dr. Mueller suggests that “institutions should be clear that disruptive behavior is unacceptable and should have formal processes for handling disruptive behavior.” The Council on Ethical and Judicial Affairs recommends that medical institutions “develop and adopt by law provisions or policies for intervening in situations where a physician's behavior is identified as disruptive. The policies should contain procedural safeguards that protect due process.” The Council warns that suspension of responsibilities should be a last resort and the confidentiality of those reporting disruptive behavior should be protected.

Preventive actions can yield positive results. "During my career, I have had a number of experiences with disruptive physicians,” said Dr. Mueller. “One encounter ended up being gratifying as the physician responded to formal feedback and remediation. Furthermore, the nursing and allied health staffs who worked closely with this physician were grateful that I had confronted the colleague and took appropriate actions."

The Bottom Line • Disruptive behavior can cause high staff turnover and decrease patient care.

• An unfocused practice can lead to increased malpractice risk.

• A process for addressing concerns should be established within each medical practice.