There are just some people who should not be allowed to manage others. Thats my take-away from an educational session I attended last month at the Medical Group Management Associations annual conference in San Diego. The session was called, The Disruptive Physician: A Hidden Threat to Healthcare, but the lessons from the session could be applied to any person in a supervisory role in any type of workplace. The fact that more than 100 MGMA meeting attendees jammed the sessions standing-room-only conference room suggests Im not alone in that opinion.
Larry Veltman, M.D., an obstetrician/gynecologist by trade, began his hourlong presentation with an anecdote he picked up from the previous evenings opening reception. He said that while waiting in the pizza line he spoke with a medical practice executive who said one extremely disruptive physician was solely responsible for the resignation of 42 employees at the executives large practice over the past 22 months. He didnt say exactly what the physician did that was so disruptive, but he did define what he called a spectrum of unacceptable physician behavior that, if left unchecked, puts patients at risk for poor quality care and safety breaches. They include:
- Angry outbursts, rudeness, verbal attacks, profanity.
- Intimidation that inhibits safety conversations.
- Physician threats, harassment, actual attacks.
- Noncompliance with existing policies.
- Sexual harassment.
- Idiosyncratic, inconsistent, passive-aggressive orders or demands.
- Derogatory comments about the organization.
- Disruption of smooth function of the healthcare team.
Stories of executives in other industries who misbehave in the same manner are plentiful. And what causes that sort of behavior? Among the reasons Veltman gave as far as physicians were concerned were that they learned it from a mentor, were experiencing some form of mental illness or diminished competence or were acting out in frustration over such things as increased oversight or their own poor business acumen.
Veltman, whose own speaking style I would describe as upbeat and conversational, expressed a fair amount of optimism that medical practices could get badly behaving physicians to change their disruptive ways with a variety of interventions. Im not so sure.
At one point, he acknowledged that disruptive physicians tend to trivialize the effect of their behavior on individuals. In other words, theyre so focused on themselves that they cant even imagine how their actions would have a negative effect on those around them. During the question-and-answer period that followed, many of the really scary anecdotes shared by the attendees would seem to back me up. For example, one told of a physician who when annoyed would find his way to his clinics fuse box and flick off the clinics electricity for a moment, then turn it back on. Thats probably not a good thing if a patient is undergoing a minor procedure from another physician in another examining room. Ouch.
All of this made me a little skeptical about how effective the Joint Commissions new code of conduct accreditation standards will be after they take effect a little less than two months from now. The new standards will require hospitals to put in place policies and procedures to police and correct intimidating and disruptive behavior not just by physicians but by all employees. Good luck with that. It might be easier just to lock up the fuse box.
David BurdaEditorModern Physician