Differentiating impairment and disruptive behavior

Sometimes well-intentioned medical staff leaders limit their effectiveness by confusing disruptive behavior with impairment. If an underlying impairment is the cause of disruptive behavior, our impulse is to heal it by providing a therapeutic intervention. But in many cases, the problematic behavior is part of the style or character of the physician.

Sometimes an underlying impairment manifests itself as disruptive physician behavior. Therefore, keep this possiblity in mind when developing a "differential diagnosis" of a physician's disruptive behavior. If the first few interventions that attempt to change this behavior are ineffective, they should at least trigger consideration of an underlying impairment.

While managing a physician's disruptive behavior, an outside assessment may be necessary. Such an assessment should not simply be an interview with a psychiatrist on your staff--any physician can, and usually does, look remarkably good in a single interview.

Instead, the evaluation should be conducted by an organization with experience and expertise in diagnosing and managing physician behavior problems. In addition to an interview with the physician, the evaluation should include psychometric testing and interviews with collateral sources, such as a spouse, partner, and office and hospital staff.

If a physician resists such an evaluation, your policy should make clear that it is within the authority of medical staff leaders to require it.