Managing the Disruptive Physician Part 1: Why is managing disruption so important?

Physicians today are charged with the painfully difficult task of ridding our hospitals of a “hostile working environment” by eliminating disruptive behavior that interferes with patient care.

This five-part series will explore why this is such a vexing and important problem and will give you specific techniques for approaching a disruptive colleague. I will discuss some of the most effective interventions to eliminate the disruptive behavior itself and recommend corrective action, if absolutely necessary. The five parts are organized as follows:

• Part 1: Why is managing disruption so important?
• Part 2: The Performance Pyramid: How to Achieve Great Performance
• Part 3: The performance pyramid approach to managing poor or marginal performance
• Part 4: How to apply the pyramid approach to managing disruptive behavior
• Part 5: Specific interventions you can take for dealing with disruptive behavior that cannot be prevented or mitigated

Why do we have to manage disruptive behavior today? First, it is the law of the land. Title VII of the Civil Rights Act of 1964 (as amended in 1991) states that treating anyone in the workplace in a demeaning and disrespectful manner is a form of discrimination under federal law. Many states have similar statutes regarding discrimination in the workplace.

In addition, The Joint Commission’s 40th sentinel event alert released on July 9, 2008 woke up those in the healthcare profession, alerting them that behaviors tolerated in the past are no longer acceptable. It describes behaviors that undermine a culture of safety and states that intimidating behavior often leads to staff turnover and failures to communicate vital patient care information in a timely manner.

But disruptive behavior has a poignant and devastating human face as well. The following is a fictionalized account of a true story addressing how inadvertent disruptive behavior led to two unnecessary patient deaths:

An OBGYN in small-town American was not only considered the best surgeon at her hospital, but also the best physician. She had trained at Johns Hopkins University but chose to practice in a small community instead of pursuing a prestigious academic career because she believed deeply that a physician’s mission is to heal and to relieve pain and suffering on a one-on-one basis. She was dedicated to her patients and attracted an enormous local and regional following because of her high standards and professional excellence.

But then things began to change. Her colleagues noted that she was becoming increasingly moody and reclusive over time. She suffered increasing marital discord, and her husband eventually left her after 10 years of marriage. Nurses noted that she became terse during rounds and over the telephone, and they began to avoid calling her on the phone to relate important patient information because she would occasionally burst into an abusive tirade.

One night, a post-operative hysterectomy patient’s blood pressure began to drop and the covering nurse called the OB/GYN to relay this information. The physician told her to never bother her again in the middle of the night for such a trivial matter and slammed down the phone. The 40-year-old patient later died from hemorrhagic shock due to a ligated artery that had broken open following surgery. Three months later, a similar event took place with a 38-year-old patient who became septic from retained products of conception following a delivery.

As it turned out, this OB/GYN was suffering from undiagnosed depression and was unable to manage her clinical practice. She took a leave of absence, underwent treatment, resumed her practice, re-married, and developed a successful practice. The two deaths were devastating to her. She apologized publicly to both families, and now attends their annual family memorials. In addition, she works with the medical staff at the hospital to help other colleagues whose disruptive conduct may be a manifestation of undiagnosed impairment and to eliminate disruption from the workplace. At a medical staff meeting following her return, the OB/GYN turned to the chief of staff and asked, “Why didn’t you help me all those years I was suffering from depression?” The chief of staff replied, “I thought we were helping you by looking the other way.”

Beyond the regulatory standards and the legal requirements, this is why we should eliminate disruptive conduct: to help our colleagues in need and to prevent senseless tragedies from befalling those to whom society has charged us to care for and to protect.

I hope that you find this series timely and useful.

All the best,

Jon Burroughs, MD, MBA, CMSL
Senior Consultant,
The Greeley Company