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The DO | Special Coverage | OMED 2012

How physicians can deal with a disruptive colleague

Rude, rogue, threatening and destructive physicians create a spectrum of consequences that adversely affect health care quality and patient safety, Steven D. Kamajian, DO, stressed this morning during an OMED 2012 session sponsored by the American College of Osteopathic Family Physicians.

Dr. Kamajian

The keys to addressing a problem physician? Courage, collaboration and confrontation, says Steven D. Kamajian, DO. (Photo by Patrick Sinco)

“The disruptive physician dictates the cadence and pace of everything we do,” Dr. Kamajian said. “Those of us who are older remember being students to surgeons or internists who could become violent or angry in the course of their conversations with us. I vividly remember many attending physicians starting conversations of with such remarks as, ‘Even a gerbil could understand this. Why are you questioning me?’ And I’ve seen operating rooms in which surgeons have thrown scalpels.

“In today’s younger generation of physicians, disruptive behavior tends to be less overt. But it still creates horrendous problems.”

Dr. Kamajian cited several studies that show a connection between aberrant or intimidating physician behavior and medical errors. One such study of health care workers at 102 nonprofit hospitals found that two-thirds of respondents perceived a link between disruptive behavior and medical mistakes, while nearly 1 in 5 respondents knew of a mistake that occurred because of an “obnoxious doctor.”

What’s more, a Veterans Health Administration survey of more than 2,500 respondents across the country documented that 90% of respondents witnessed disruptive physician behavior and 33% of respondents reported that a nurse resigned due to a physician’s behavior.

Not just throwing scalpels

Disruptive behavior takes many forms. Sometimes physicians have total disregard of the schedules of their patients and other health care professionals. “Many of you in family medicine will have colleagues who schedule patients for 9 a.m. but won’t show up until 10 a.m.,” said Dr. Kamajian, a family physician in Montrose, Calif. “Sometimes we have anesthesiologists keeping patients asleep for three hours before the surgeon even enters into the operating area.”

Physicians have been known to throw charts at staff and use profane, disrespectful or sexually suggestive language. They may ruin morale by criticizing other health care professionals in front of patients. Or they may create an intimidating environment that suppresses suggestions from other health care professionals.

“It could be something as simple as lying—lying to the patients, lying to the nurses, lying to their colleagues,” Dr. Kamajian said.

Disruptive physicians undermine patient confidence, Dr. Kamajian said. They contribute to the nursing shortage. They undermine teamwork and interfere with everyone’s ability to provide safe, effective care. And they increase health care costs.

“An interventional neurovascular radiologist recently threatened to kill an operating room technician,” Dr. Kamajian noted. “Now this is a person who is probably bringing in $2.5 million to $3.5 million in revenue to the hospital. It’s very unlikely that a hospital CEO is going to approach a man who is bringing in this much money and say, ‘You’re not worth the risk.’ But they really are not worth the risk because if they do not create errors from their hostility, they are going to create a lawsuit when a staff member sues the hospital for creating a hostile work environment.”

Responsibility

Physicians need to take the lead in dealing with disruptive physicians, Dr. Kamajian urged. “If you are the employer and the doctor you are working with is improperly charting—lying on his charts, backdating progress notes—and is frequently badmouthing peers, you can and should fire him,” he said. “But even if you are an employed physician, you still have an ethical and moral obligation to act even if you don’t have the capacity to fire.”

When tackling a problem colleague, physicians must first collaborate on documenting the boorish behavior, Dr. Kamajian stressed. “It’s better when there is somebody else who can testify that what you are saying is not your prejudice, your anger, your misunderstanding of what’s going on,” he said.

When confronting the disruptive physician, start with a “cup-of-coffee conversation,” to let him or her know that the questionable behavior is not acceptable and will not be tolerated, Dr. Kamajian suggested.

“When you see disruptive behavior, act courageously,” he stressed. “Understand your own strength.”

For audience member Oliver M. Gherardi, DO, Dr. Kamajian’s presentation hit home. A family physician in Providence, R.I., Dr. Gherardi is changing jobs because of the stress and conflict created by a disruptive peer. “I brought up the problems with my supervisor, but my concerns were disregarded,” he told The DO.

Although he is leaving his employer, Dr. Gherardi plans to follow Dr. Kamajian’s advice to be more assertive in addressing and reporting the problematic behavior. “I need to be more forceful,” said Dr. Gherardi, “for the sake of the staff members I am leaving behind.”

cschierhorn@osteopathic.org

4 Responses

  1. franklin Harrison, DO on Oct. 11, 2012, 8:33 p.m.

    I agree with and like your comments but I think you left out one very important consideration–that being that a potentially high percentage of disruptive behavior is due to substance abuse–whether it’s because the physician is hung over from last nites cocktail “hour” that lasted many……or because he is loaded at the time—–both of these I submit to you are impaired and their disruptive behaviors cause much more harm than hurt feelings and lawsuits……patient lives are in jeopardy!!! Respectfully, Franklin Harrison,DO.

  2. robert migliorino,d.o. on Oct. 16, 2012, 8:14 a.m.

    Very true,especially the person who brings large dollars into the facility. No admin in his right mind would even consider suspension or termination.For them,the almighty dollar rules!

  3. Vanderbilt CPPA on Oct. 18, 2012, 4:04 p.m.

    It is important that physicians take a leading role in dealing with disruptive physicians. However, that alone is not enough. In the day-to-day work environment, your leaders need the skills to conduct collegial and non-punitive “cup of coffee”, “espresso” and “awareness” conversations with healthcare professionals in a reliable and consistent manner supported by the organization’s policies and procedures. Every organization needs a supportive infrastructure (policies, procedures, transparency) and leadership support (policies are consistently and fairly applied) to allow an environment where professionalism and accountability can thrive. Everyone needs to feel empowered to speak up knowing leadership has their back. Supportive infrastructure, leadership commitment, and physician leader training in difficult conversations can make the difference.

  4. Maurice Robinson, D.O. on Nov. 2, 2012, 5:16 p.m.

    As a many-year member of hospital leadership, the “cup of coffee” discussions are rarely effective. That’s not to say that they shouldn’t occur, but without proper documentation of the behavior no disciplinary action is enforceable without legal repercussions. Hospital bylaws regarding so called disruptive behaviors are often vague and open to varied interpretations and in some cases may be a venue to launch a personal vendetta. Video surveillance of nursing work stations, operating rooms and physician work areas is a credible piece of reinforcing
    evidence and an active, broad-based physician leadership is imperative.

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