How to Recognize—and Stop—Inappropriate Physician Behavior

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Disruptive physicians are a problem across all medical specialties, and otolaryngology is no exception. A 2011 survey of 800 physicians found that disruptive behaviors occur in more than 70% of hospitals each month (QuantiaMD.com, May 15, 2011). These actions, if not addressed, have been linked to lower satisfaction for patients and their families and can affect not only physician reimbursement but also physicians’ risk management experiences and malpractice lawsuits (JAMA. 2002;287:2951-2957).

Disruptive behavior in hospitals can also endanger patient safety. The Joint Commission issued a sentinel event alert in 2008 that requires hospitals to have a code of conduct and a process for managing disruptive and

inappropriate behaviors (The Joint Commission. July 9, 2008). In 2000, the American Medical Association issued guidelines on what constitutes troublesome actions and how to handle them (American Medical Association. December 2000).

Defining Disruptive

“The definition of a disruptive doctor has narrowed over the last couple of decades,” said Robert T. Sataloff, MD, DMA, professor and chair of the department of otolaryngology at Drexel University in Philadelphia. “Behaviors that would have been classified as idiosyncratic 10 to 20 years ago are now seen as disruptive.”

There may be a fine line between being disruptive and just being a jerk, but treading that line can bring problems to the practice. “Some physicians are just not people pleasers that you want to socialize with; they may be curt, arrogant, unfriendly, or not effective communicators,” said Judith Holmes, JD, of Judith Holmes and Associates, and co-creator of Master Series Seminars, LLC, both based in Denver. “But those who won’t win congeniality awards do not necessarily fit the model of the disruptive physician.”

Bad Behaviors

Holmes said that abusive and demeaning behaviors are the most likely to cause problems. These would include:

• Making threats;
• Shouting or throwing things;
• Making condescending comments;
• Criticizing a colleague in front of a patient or other staff members;
• Vocalizing sexually inappropriate comments;
• Touching a colleague in a sexual way;
• Verbally harassing or mocking a colleague, which can lead to legal liability if it involves a person’s age, race, gender, disability, religion, pregnancy, or other protected category; and
• Refusing to comply with established policies and procedures.

It is important for a physician practice to have policies and procedures in place, preferably before there is a problem, that not only outline the types of behaviors that will not be tolerated, but also describe the interventions that should be undertaken if rules are broken and delineate the consequences that will be enforced if those interventions fail. “One of the best ways to deter bad behavior is to implement a comprehensive code of conduct,” said Holmes. “This should include a clear policy defining unacceptable behaviors and should have a clear disciplinary policy outlining the procedures used to deal with complaints.”