Unprofessional Physician Behavior Raises Discipline Dilemma, Patient Care Concerns

The American Medical Association (AMA) has identified four distinct forms of unprofessional conduct by physicians—1) inappropriate behavior, 2) disruptive behavior, 3) harassment, and 4) sexual harassment. These misbehavior sets can be considered to “peg” the continuum of unprofessional conduct previously mentioned. Of these four, this ethical scenario addresses both inappropriate behavior and disruptive behavior. According to the AMA definition, inappropriate behavior is “conduct that is unwarranted and is reasonably interpreted to be demeaning or offensive. Persistent, repeated inappropriate behavior can become a form of harassment and thereby become disruptive.” As seen from this definition, inappropriate conduct can encompass a wide range of behaviors as both physicians in the scenario exhibited. Left unchecked, such behavior can negatively affect patient care and staff morale, potentially having a cascading effect within a healthcare facility or medical group practice. In an academic setting, this will have a negative impact on role modeling and will compromise training in professionalism. Examples of inappropriate behavior include making demeaning statements, demonstrating arrogance, dismissing patient questions, and speaking disrespectfully to patients and medical team members.

Disruptive behavior is likewise characterized as “any abusive conduct, including sexual or other forms of harassment, or other forms of verbal or non-verbal conduct that harms or intimidates others to the extent that quality of care or patient safety could be compromised.” The behaviors included in this type of misconduct tend to be more serious with respect to patient care and staff morale and, if left unchecked, will assuredly lead to legal ramifications. This is why unprofessional behavior by a physician must be dealt with as soon as possible, with each case managed as appropriately as possible, according to medical staff rules of conduct. Disruptive behavior is seen with surgeons who are verbally abusive and throw instruments in the operating room, make errors in clinical judgment that could be due to impairment, or intimidate the nursing or pharmacy staff sufficiently that they are unwilling or unlikely to question an inappropriate/ineffective order or to pose a patient care or patient safety concern.

The primary goal of dealing with unprofessional behavior will be to protect patients and ensure safe and appropriate clinical care. Secondarily, the staff must be protected from the unprofessional physician. A third goal is to develop an appropriate remediation or recovery plan for the physician so that he or she has the chance to return to the practice of safe, appropriate, and professional medical care. Finally, the institution itself must manage possible medico-legal risks.