Disruptive Physician Mandate Creates Problems for Healthcare Organizations

Summary: The lack of clear definitions of what "disruptive behavior" is making it difficult to implement this new mandate.

           

Physician Well-Being Committees nationwide are struggling to implement the January 2009 Sentinel Alert relative to mandated intervention for “disruptive physicians”. Part of the confusion is related to the lack of clear distinctions between physicians who are impaired and those who are “disruptive”. Psychiatric impairment is a defined medical disability. The new “disruptive physician” category is actually purposeful bad behavior rather than a pathological condition. Anger is not a mental or nervous disorder and is not listed in the DSM-IV.

Unfortunately, there are some unscrupulous substance abuse providers who are claiming that “disruptive physicians” are actually addicted to anger and therefore should be diagnosed as rageaholics and treated like any other addict.

What is disruptive physician behavior?

According to Kimberly Ware, Esq., “A single occurrence and/or pattern, of overt and/or passive conduct that is (or is reasonably likely to be) detrimental to patient safely and/or to the delivery of patient care.” More specifically, verbal or non-verbal communication that is demeaning, hostile, aggressive or passive aggressive and is designed to intimidate or control the actions of others is likely to be considered disruptive.

Some examples of obvert behavior include:

• Throwing objects in the operating room

• Yelling, put downs or name calling

• Verbal abuse

• Threats

• Intimidation

• Retaliation

Example of passive or subtle disruptive behavior:

• Failure to respond to pages or requests for medication orders

• Withholding information or help

• Disrespectful gestures

• Unreasonable orders or demands

What are the most appropriate intervention resources for “disruptive physicians”?

A careful examination of the behaviors that are considered “disruptive” are no different than those behaviors which create a hostile work environment or are the subject of criminal prosecution such are road rage, simple battery, desk rage, verbal abuse or other forms of person or property directed aggression or violence.

In summary, inappropriate public displays of anger generally subject the perpetrators to prosecution and mandated classes in Anger Management or Coaching for Civility.

The three most widely recognized resources for “disruptive physicians” in the U.S. are:

• The PACE Anger Management Program for Physicians at the University of California School of Medicine at San Diego

• The Distressed Physician Program at Vanderbilt University School of Medicine in Nashville, Tennessee

• The Anderson & Anderson Emotional Intelligence/Anger Management Coaching Program for "disruptive physicians" in Los Angeles, California.

These three programs were designed specifically for physicians in need of skills in recognizing and managing stress, recognizing and managing anger, increasing emotional intelligence/empathy and mastering assertive communication. All of these programs are based on skill enhancement in Emotional Intelligence rather than Psychotherapy or Substance Abuse Treatment.