Abstract
This timely article provides current information on an age-old issue of disruptive physician behavior within the hospital setting. Documented in medical literature over 100 years ago, disruptive physician behavior has been an ongoing challenge to the hospital staff and the quality of patient care in the hospital. Covered in this article are the negative consequences of disruptive physician behavior and the call to respond. If allowed to go unchecked, a physician exhibiting disruptive behavior may threaten a hospital's image, staff morale, finance, and quality of care. Failure to respond undermines the leadership of the hospital and the trust of the community in the hospital's mission. Included in this article are suggestions obtained from the literature and from the author's experience in responding to disruptive physician behavior. Of emphasis is a methodology that includes supporting bylaws and policies to manage disruptive physician behavior.
DISRUPTIVE PHYSICIAN BEHAVIOR has a long history with increasing prevalence in hospitals across our nation. A review of the current literature provides insight to the significance of this negative behavior on quality patient care from several perspectives. This article provides several suggestions to the chief executive officer (CEO) of hospitals in addressing the phenomenon of disruptive physician behavior.
Today, more than ever, CEOs must ensure that hospitals are as effective and efficient as possible in the competitive landscape of healthcare. A physician with disruptive behavior may threaten the hospital's image, morale, finances, and quality of care if allowed to go unchecked.
The CEO is by position a leader in the hospital setting. It is understood that for a hospital to be successful in its mission of the delivery of quality patient care within the community, it must have an effective leader. A good leader in healthcare must have a clear vision and the ability to communicate that vision, and the leader must set the highest standards of performance for employees.1 A factor that can negatively impact performance is the phenomenon of disruptive physician behavior.
CEOs of hospitals face and decide on many issues in the sublime duty of ensuring quality patient care in a safe and caring environment. Nothing can be more undermining to this duty and the quality performance of the hospital staff than the disruptive behavior of physicians. No issue so compels the complexity and dynamics of ensuring a safe environment with quality delivery of patient care than confronting a physician whose behavior is disruptive;2 the behavior sends a negative ripple in the sense of harmony and safety in the one setting where these attributes are paramount for quality patient care.2
Today, more and more CEOs of hospitals are addressing the disruptive physician behavior syndrome.2,3 CEOs who are confronting the physician exhibiting disruptive behavior are experiencing the complexity of the dynamics in dealing with the alleged disruptive physician. In a world of litigation and paranoia, the tenuous decision is whether to ignore the problem or risk being accused of attempting to destroy a physician who many may say is a great physician but may simply show too much passion at times.
These alleged disruptive physicians fall into 2 quintessential stereotypes: (1) The old guard: This is the physician who has many years on the staff including a history of holding the offices of Chief of Staff and being a prominent member of the medical society and the community. However, everyone who associates with the physician knows the thin threshold that triggers explosive and disruptive behavior. (2) The trauma drama: This is the very young physician who is so motivated and well liked because of energy, tempo, and passion yet has a very thin threshold for triggering explosive and disruptive behavior. Several factors are known about these 2 types, the old and the young: they are usually clinically excellent physicians, they are usually highly intelligent, and they have quick and sensitive triggers for exploding toward the staff. Nevertheless, they are well liked and admired by their patients and by the community. Wilkerson reports that they are usually obsessive-compulsive as well as narcissistic, and they have some degree of paranoia as well.4
The CEO faces an approach/avoidance conflict issue in addressing these physicians. In approaching this issue, one opens a stormy landscape of reaction not only from the physician but also from all of the physician supporters. These supporters will claim that the CEO is attempting to destroy the physician. Yet more disconcerting, if the CEO fails to act, the morale and the hospital quality culture and eventually its quality of care and image will be compromised in the long-term. The disruptive physician undermines morale, alienates staff, heightens turnover, drives down productivity, increases risk of substandard quality care and malpractice suits, and drives away patients.3,5 For the singularity of the act of addressing the disruptive physician, many CEOs are reluctant to respond to disruptive physician behavior. For many years, physicians exhibiting disruptive behavior have been largely ignored or excused by those who project the attitude: "That is just the way they are." Dewitt wrote that "it is a help to a doctor, especially to one who is full of crotchets, to have as an assistant, a nurse who 'knows his ways' and who is not disturbed by his explosions of impatience."6