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July 27, 2015

Five strategies to deal with disruptive doctors

Daily Briefing

Editor's note: This story was updated on March 6, 2018.

Disruptive physician behavior is a problem at many hospitals, negatively affecting staff retention, patient safety, and the bottom line. But too few providers take the necessary steps to address the issue, Mark Crane writes for Medscape.

More than 70% of doctors say they witness disruptive behavior by physicians once or more per month at their organizations, according to a 2011 study by the American College of Physician Executives and QuantiaMD. And more than one in ten doctors said they saw such incidents happen every day.

Such behavior can range from doctors having a bad attitude toward patients and staff and losing their temper to refusing to follow an organization's charting policies. But often clinicians wait to report an issue until after it already has had a negative effect on patient safety, according to experts interviewed by Crane.

Harvard School of Public Health professor Lucian Leape says that doctors are often hesitant to speak up about problems because of the value placed on independence in the medical profession. And when an issue is reported, department chairs tend to lack the necessary training to address the issue or hesitate because of the doctor's effect on revenue, Leape adds.

Fixing the problem

Experts say there are several strategies providers can employ to reduce disruptive behavior.

1. Create a code of conduct. Hospitals and group practice should have a code of conduct that clearly lays out what behavior is expected of staff, says consultant Will Latham. That way, managers can focus on clinicians' behavior, rather than on their personalities overall. The code of conduct should also spell out a point-of-contact for submitting complaints, Latham suggests.

2. Don't back doctors into a corner. Providers should generally first broach the topic of disruptive behavior in meetings between one or two organization leaders and the problematic doctor in an informal setting, such over coffee, says consultant Ken Hekman. Some physicians are unaware that their behavior is causing issues, so leaders should have a respectful tone, focus on specific problem behaviors, and ask the doctor for suggestions on improving the situation, Hekman adds. But providers need to take more formal approaches to addressing issues such as allegations of sexual harassment.

3. Give physicians options. Bad behavior can often be the result of burnout among doctors, explains Halee Fischer-Wright, president and CEO of the Medical Group Management Association. Fischer-Wright urges providers to approach physicians in a "collegial" manner and offer them options, such as additional help or time off. That way, the doctor does not feel like he or she is being attacked, she says.

4. Know when to take further action. If the issue is still unresolved after informal conversations, experts recommend holding more formal discussions with disruptive staff with senior partners and the practice administrator, who can help outline a plan for improvement. But if that still doesn't work, leaders may have to put the doctor on mandatory leave and threaten termination if his or her behavior does not improve, Hekman says.

5. Improve the hiring process. Providers can head off much of the problem of disruptive behavior by making better hiring decisions, experts say. Fischer-Wright recommends that providers spend more time with prospective candidates and involve more people in the hiring process. And "if there are warning signs or you get a gut feeling, pay attention to that," she says. Experts also recommend putting more focus on a prospective hire's character, integrity, and personality, and attempting to speak to as many references as possible (Crane, Medscape, 7/23).

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