According to the experts, there are two ways physician executives should deal with a misbehaving doctor. One method is to handle the doctor causing the trouble. The other is to work on the leader in the mirror.
Either way, problem physicians are just that: problems.
In January, Modern Physician published the results of a poll of our 15-member physician executive editorial advisory board on 56 healthcare management issues. Their strongest response-9.1 points out of a possible 10-came in agreement with the statement that physician behavior is an important concern in reducing medical malpractice liability and improving patient safety.
This article and accompanying columns by Francine Gaillour, M.D., and Michael Woods, M.D., address this important problem.
"We're seeing it as one of the top three issues raised by physician leaders across the country," concurs Richard Scheff, M.D., vice president of consulting and education for The Greeley Co., a Marblehead, Mass.-based consulting firm.
"Behavior that was tolerated in the past is no longer being tolerated," Scheff says.
Create code of conduct first
When dealing with problem doctors, Scheff suggests starting with a physician code of conduct. If your organization doesn't have one, it should get one in writing, he says.
A committee of physician executives should begin the work on the code, but they should pass their draft around to the rank-and-file for input and revision so the final product represents every physician in the group, he says.
"What's most important is that they answer for themselves what they mean by being a good doc," Scheff says. "Discussion, eyeball to eyeball, is what creates the culture. Down the road, we have to be able to say, 'Remember when we agreed on that?' If you can't say that, it's awfully hard to discipline a physician."
The code, to be effective, can't just go into a binder and gather dust, Scheff says. It needs to be periodically revisited as well as presented to every physician candidate, and consented to by them, before they are hired or brought into the group or hospital, he says.
But acute problems still will arise, and the time to investigate a complaint and take action is immediately, says John Pollard, M.D., former CEO of Carle Clinic in Urbana, Ill. Pollard teaches a course on how to confront disruptive physicians as part of the American College of Physician Executives' "Tutorial to Become a Certified Physician Executive."
With the growing potential for bad conduct to create legal problems, from sexual harassment complaints to medical malpractice claims, ignoring misbehavior is no longer an option, Pollard says. He advises physician executives to hear the complaint, then try to verify it by interviewing witnesses to the offensive behavior.
Then, a one-on-one conversation with the offending party is often all that's required. With a repeat offender, however, physician leaders should refer to a formal code.
And, Pollard reminds, "If it's not in writing, you haven't got one."
Looking within and taking stock of your own behavior patterns will give you greater competency and success in dealing with the problems of others, say gurus of the philosophy of applying emotional intelligence to leadership. And your organization will run better, too.
"You have to be empathic to where people are coming from," says Brian Campion, a cardiologist and lead faculty member of the Physician Leadership College, an 18-month training program for physician executives, at the University of St. Thomas in St. Paul, Minn. "One of the real issues is physicians are never taught these kinds of skills."
By the time most physicians go into practice, experts say, it's too late to develop those skills without concerted effort. That's because, research suggests, emotional reactions are centered in the brain's limbic system, a "open loop" system that depends on external sources to manage itself, according to Daniel Goleman, writing with Richard Boyatzis and Annie McKee on what they call "Primal Leadership" in the Harvard Business Review.
Some emotional responses are hard-wired by genetics, Goleman says, but we also rely on connections with other people to determine our moods. Thus, he says, our own responses are cued by the emotions of others, though our emotional skills are fairly well set by the time we reach our mid-20s. As a mature adult, it takes a five-step process to learn new emotional skills such as empathic listening or anger management, Goleman says.
The learning begins by writing out a vision of the skills and behavior patterns you want for yourself, followed by a 360-degree analysis by peers and subordinates to get a clear idea of where you meet and fall short of that vision. Then you devise a plan to close the gaps between your vision and your reality, followed by practicing techniques learned to close those gaps. Finally, you work within a supportive group of fellow learners to ease you over the rough spots.
Goleman, et al., say the emotional pattern set by a leader is observed and mimicked by peers and subordinates and permeates an organization. Thus, the leader's emotional intelligence is a key to the success of both the leader and the group.
Raising a leader's emotional IQ takes patience and time, says Jane Thilo, M.D., an advocate of the Goleman approach. Thilo, an anesthesiologist, heads the leadership coaching firm JThilo & Associates, of Mercer Island, Wash.
"It just takes repeated practice" at work, at home and at social settings, she says.