Unprofessional Physician Behavior Raises Discipline Dilemma, Patient Care Concerns

There are many potential causes for unprofessional behavior by physicians, but a few seem to be most common: 1) personal or situational stress factors in a physician’s life; 2) financial pressures (real or self-imposed); 3) medical or mental health disorders; and 4) substance abuse (drugs, alcohol). An investigation of complaints against a physician in the ethical scenario presented above would logically consider these potential predisposing factors.

Indeed, it is your responsibility, as chief of surgery, to address these complaints. If left unaddressed, they will continue to be problematic and may, in fact, worsen. In allowing this to happen, you are stepping into a very difficult and potentially risky professional confrontation; however, you need not address these situations alone—it is important to include several other surgeons who can broaden the discussion on the best approach to take with each surgeon against whom complaints have been lodged. The surgeons you take into your confidence should be well respected for their professionalism and confidentiality, and your ad hoc committee composition should comply with the medical staff bylaws.

It is important for every healthcare facility, academic medical center, and physician group practice to have a well-developed medical staff code of conduct. The AMA Model Medical Staff Code of Conduct (available at ama-assn.org) is an excellent document and blueprint for this sort of ethical dilemma. By having each physician on the medical staff review and sign the code of conduct document on a regular basis, a practice can hold its physicians to these standards. The medical staff bylaws should clearly state the procedures for reviewing and investigating complaints against medical staff members and direct the proper process for disciplining and/or remediating a physician whose misconduct has been adequately substantiated. I will refer the reader to the AMA document for details.

It is likely that some cases of unprofessional behavior will turn out to be situational or stress-related and can be remediated by informal or formal counseling. More serious inappropriate or disruptive behaviors require identifying the underlying etiology—physical or mental health issues or substance abuse—and mandating the appropriate treatment plan or facility for that physician’s disorder. There are many treatment facilities in the U.S. for physician remediation and recovery, but local resources may also be adequate and appropriate. Reinstatement is possible after successful completion of a course of therapy, usually with a period of close oversight over the physician’s practice. More serious cases of unprofessional behavior will be reported to the state medical board for its separate investigation and possible discipline.