Michael Benninger, MD, chairman of the Head and Neck Institute at the Cleveland Clinic, said, “Healthcare environments should be environments of people being able to raise concerns without retribution, and they should be comfortable exposing potential problems.”
Explore This IssueMarch 2016
In the urology literature, those running simultaneous operations actually have been found to have the better outcomes, he said, although the question of which portions of the procedures are performed by the surgeon is a critical factor. “There are a lot of things going on here, but the whole idea of disclosure and consent, I think, is the most important,” Dr. Benninger said.
Another fictional case involved a 67-year-old surgeon who had always been a team player, willing to cover for colleagues, but over the previous few months had shown dramatically different behavior, growing abusive toward residents and arriving late to office hours and the operating room.
Dr. Benninger said he would wonder, “Is this just a competency issue, or is this something else? I would be concerned about drug and alcohol use for somebody who had a relatively sudden change. The other [possibility] would be early Alzheimer’s Disease.”
Dr. Bradford said substance abuse is “a real problem” that requires appropriate and immediate medical intervention. Her university has an evaluation and coaching program for the disruptive physician that can have impressive results. “For the physicians who have been in that program, most acquired a skill set that was helpful in their professional and personal lives, and they very, very much appreciated the education,” she said. “I would have anesthesiologists contact me after the fact and say, ‘I don’t know what you did, but it was really, really helpful.’”
Dr. Grundfast said that he confronted a situation involving an aging physician whose skills had seemed to be deteriorating, used the hospital’s mandatory “Ongoing Physician Professional Evaluation” (OPPE) process as a way to monitor the physician’s competency, and then had conversations with the physician centered on the formatted OPPE. The physician was entirely cooperative and, soon after the evaluation process was under way, he decided to retire. “It was extremely difficult to confront this individual, who is now well up in years,” Dr. Grundfast said. “And the way it was done was with some candid conversations.”
Dr. Stewart said that sometimes a simple conversation over coffee can have real effects. Occasionally, a physician whose behavior is becoming a problem may shrug it off, but sometimes they have no idea. “Just sitting down with them and having an honest conversation can make a big difference,” he said. The reaction will sometimes be: “Really? Have I really missed this?”