What to do when a skilled physician acts out

What do you do when a physician exhibits behavior outside of the norm? Consider this scenario:

A hospital had a skilled internist who had been reported for unprofessional, rude, or otherwise discourteous behavior six times in the last three months. The physician has been a member of the hospital's medical staff for seven years and has never before exhibited problematic behavior. The hospital's medical executive committee (MEC) was reluctant to revoke the physician's clinical privileges.

The hospital received three incident reports before bringing the physician to the MEC's attention. At that point, the MEC decided to monitor the physician's performance. However, three additional reports were received during the next month. Although the physician did not receive any feedback regarding his behavior, the department chair requested that the MEC conduct a formal investigation.  

What should the hospital do next?

First, appoint a medical staff leader, perhaps in conjunction with a management representative, to investigate the validity of such reports. Management and a key member of the medical staff should verify the information through direct discussions with individuals directly involved.

Once armed with the results of this investigation, the chief of staff and board representative should meet with the physician. The physician's behavior should be presented rather than debated at this meeting. The confirmed reports should simply be reviewed, and the chief of staff and board representative should voice their concerns.  

At the conclusion of the meeting, the board representative and chief of staff should make it clear to the physician that his behavior won't be tolerated. As nicely, but as firmly as possible, the physician should be encouraged to review and amend his own behavior. The physician should be warned that further episodes of unprofessional behavior will result in specific actions meant to protect employees, patients, and other physicians.  

Remember, it is irrelevant whether the physician agrees that his behavior has been inappropriate. The hospital should offer the physician support by arranging periodic meetings for him with the chief of staff or an experienced member of the human resources team. In addition, the institution should immediately work with the MEC to develop a comprehensive policy for dealing with disruptive physician behavior. Once passed, this policy should be presented to all physicians on staff.