CON

The impact of being branded by a "scarlet letter" in Nathaniel Hawthorne's time pales in comparison to what is wrought upon unsuspecting practitioners labeled as "disruptive" in today's medicine. Virtually irremovable once affixed, the brand of "disruptive" can summarily ruin an otherwise brilliant medical career and should prompt every practitioner to immediately, and aggressively, risk manage their practice to avoid even the inference of any such status.

"Disruptive"-defined in countless fashions throughout medical staff bylaws, employee manuals/handbooks and other governing rules and/or regulations-is basically any style of interaction with practitioners, hospital personnel, patients, family members, or others that is deemed to interfere with patient care (American Medical Association, 2001; The Joint Commission, 2008). While no one questions the need for the orderly administration of patient care, the abuse of that worthwhile goal is revealed when one considers the stunning breadth of "any style of interaction"-interpreted by some to include even facial expressions, tone of voice and/or body language. "Disruptive" may include profanity, hostility, insensitivity, sexuality, and incompatibility. Equally disturbing is the question of who will hold the power to "deem" such interactions to be disruptive? Does that person hold inappropriate (i.e., economic, personal, etc.) or appropriate motivations? Further, and in essence, is there anything that cannot be "deemed" to "interfere with patient care"?

The overly broad and unduly vague nature of such a label as "disruptive" can only lead to further misuse and greater abuse against practitioners. I would advise practitioners to immediately obtain, review and challenge, if necessary, the following from their employer and/or their medical staff: (1) Any and all code(s) of conduct; (2) Any employee handbooks/manuals; (3) Any medical staff bylaws; (4) Any departmental procedures and protocols. If any of these are poorly defined, unworkable in its vagueness or subject to self-serving interpretation, it should be challenged immediately through the offices of the medical staff, human resources, union representatives, etc. If one accepts the "behavioral standards" in an employment setting, lack of compliance carries the risk of being adversely and permanently labeled as "disruptive."

In the event of an investigation of practitioner conduct, there is potential for serious and irreparable professional damage. Therefore, no practitioner should (1) allow a complaint to go unaddressed and/or unresolved or (2) attend a meeting concerning their status (either as an employee and/or medical staff member) without first knowing who will be attending and what will be discussed. If attending such a meeting, one should take careful and copious notes of what is said and by whom, demand an opportunity to weigh what has been presented and respond at a later point-possibly in writing, and never be coerced into signing any document or documents at such a meeting. Moreover, if an investigation is concluded in the practitioner's favor, that disposition should be in writing, and secured in the practitioner's relevant file in order to accurately, and permanently, reflect the practitioner's standing.

Every practitioner's ability to avoid the label of "disruptive" rests with whether he or she is willing to proactively secure a firm grasp of the standards by which such an adverse judgment may be placed. Then they must either abide by those standards, initiate the effort to change the standards or remove themselves from the institution. To remain silent, unaware or uninvolved will only serve to empower the structures, which seek to abuse the intentions, process and goals of those who honorably seek to address the truly "disruptive" practitioner.

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