Don't confuse a disruptive physician with an impaired physician

Dear Medical Staff Leader:

Well-intentioned medical staff leaders can limit their effectiveness by confusing disruptive behavior with impairment. Dr Spence Meighan, one of the pioneers for dealing with both physician impairment and disruptive behavior, used to say, "Dealing with an impaired physician is a labor of love. Dealing with a disruptive physician is a labor of law."

In other words, if an underlying impairment is the cause of the problematic behavior, our impulse is to heal it by providing a therapeutic intervention. This impulse frequently leads to a recommendation or requirement that the physician attend an anger management program. Sometimes such programs can be helpful. But in many cases, the problematic behavior is just part of the style or character of the physician. They must be told--in no uncertain terms--that such behavior will not be eligible for care in your institution. That is what is meant by a labor of law.

Remember that an underlying impairment can present as disruptive physician behavior. Keep this possibility 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. Depression, substance abuse, family stress, and occasionally an organic condition may be the cause of a behavior problem. Therefore, at some point in managing a physician's disruptive behavior, an outside assessment conducted by an organization with experience in diagnosing and managing physician behavior problems should be conducted.

That's all for this week.

All the best,

Rick Sheff, MD
www.greeley.com/seminars