How to handle disruptive physician behavior

Dear medical staff leader:

Disruptive physician behavior is a hot topic and many clients have asked about how to handle this thorny issue since no one likes to discuss problem behavior with a colleague.

To provide consistency for all medical staff members the disruptive behavior policy should delineate how to manage such events.

Managing behavior issues begins with a uniform way of investigating a complaint about misconduct. The medical staff should have a policy outlining how it conducts investigations to determine whether the complaint has merit. This process should include who will interview the complainant-- an appropriate individual should be selected depending whether the person is a medical staff member or a hospital employee. Next, state to whom this information is given and whom will ask the physician being investigated his or her side of the story. Finally, who will determine whether the complaint has merit?

Most of us on occasion behave like saloon bullies. We are tired, frustrated or overworked. Hospital employees and our colleagues rarely file a formal complaint for the occasional outburst unless it is particularly destructive or violent. Most of us are embarrassed by our behavior and will respond with appropriate remorse and repentance when the behavior is brought to our attention.

For this reason, usually the first conversation about an event is collegial, asking about the physician's perspective on the event, passing along a copy of the disruptive physician policy and ending with a discussion of how to handle similar situations in the future. However, this collegial conversation should be documented. But no further action will usually occur unless the physician's response is inappropriate.

A second incident, validated after an investigation, is handled more formally with a meeting, a discussion on appropriate behavior, a warning that continued incidents may result in loss of privileges, and a caution that retaliation against a suspected reporter will be treated as another incident. This conversation should also be documented in a letter sent to the physician. A third validated incident warrants a formal meeting with the physician and should include senior medical staff leaders, such as the chief of staff and the hospital's CEO. The physician should be told that another validated incident might result in suspension from the medical staff, a referral for physical and mental health evaluation, or both.  He or she is again warned about retaliation. This meeting is documented in a certified letter sent to the physician.

Another validated incident should result in immediate action. By this time, the MEC should have received reports of previous incidents and meetings with the physician and validate in advance the action to be taken should another event occur.

Next month, I will review some tips for meeting with physicians to discuss performance issues.
 
All for now,
Barbara LeTourneau, MD, MBA
The Greeley Company