Examining Effects Of Physicians' Disruptive, Abusive Behavior

Ruzanna Harutyunyan's picture

The New York Times on Tuesday examined how some physicians' negative behavior "contributes to medical mistakes, preventable complications and even death," in addition to "low morale, stress and high turnover" among hospital staff.

According to a survey of health care professionals at not-for-profit 102 hospitals from 2004 to 2007 conducted by Alan Rosenstein of VHA, 67% of respondents thought there was a connection between disruptive behavior and medical mistakes, and 18% said they knew of an error that occurred because of an "obnoxious" physician, the Times reports. One-third of the nurses in the study knew of a nurse who had left a hospital because of the behavior of a physician. In addition, a survey by the Institute for Safe Medication Practices found that 40% of hospital workers reported having been so intimidated by a physician that they did not share concerns about prescription orders and, as a result, 7% said they had contributed to a medication mistake.


William Norcross, director of a program at the University of California-San Diego that offers anger management classes for physicians, said that while the majority of physicians are trying to do the best job they can in high-pressure situations, "About 3% to 4% of doctors are disruptive ... and they really gum up the works." Experts say disruptive physicians are most likely to be specialists in high-intensity fields like cardiology, neurology and orthopedics, the Times reports.

The Times reports that "things have begun to change" as there are indications "that such abusive behavior is less likely to be tolerated." According to the Times, "Today, good communication and leadership are two of the six core skills taught in medical schools and residency programs," and hospitals are "trying to improve relations and mutual respect between doctors and nurses." Thomas Russell, executive director of the American College of Surgeons, said many hospitals now are either firing disruptive physicians or sending them to anger management classes.

The Joint Commission has required that hospitals develop a written code of conduct and a means of enforcing it. According to the Times, some physicians are concerned that the codes of conduct will be abused by hospital administrators to eliminate physicians who speak out against hospital policies. According to the Times, "[T]he Joint Commission rulings have spawned a cottage industry of anger management centers and law firms defending hospitals or physicians" (Tarkan, New York Times, 12/2).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.



As a major provider of Executive Coaching/Anger Management for "disruptive physicians", I can say with certainty that many of these physicians are motivated to change but are unaware of the resources to gain the help needed to recognize and managemant anger and stress. Neither JCAHO nor the AMA nor any of the State Licensing Boards publiish a list or directory of resources for "disruptive physicians. The two best known providers are the University of California School of Medicine at San Diego (PACE Program) and Vanderbilt University School of Medicine (Distressed Physician Program). Unfortunately, both full through July of 2009. Anderson & Anderson Executive Coaching/Anger Management for physicians is less widely known but offers non psychiatric assessment and intervention consistent with the new JCAHO standards.
Healthcare organizations nationwide, through their Physician Well-Being Committees and Credentialing Committees, are searching for appropriate resources to refer physicians who are considered to exhibit “disruptive behavior” at work. Unfortunately, the needed missing link is a directory or list of “approved programs” designed exclusively to address this issue. Doctors are a highly trusted and valued group of professionals in all cultures. They enjoy social respect, but also have significant social responsibilities. Doctors who fail to maintain professional standards and conduct cause social concern, because they may do harm to patients if their performance is poor. The loss of a doctor has effects on service provision, and may be expensive to health care providers. Doctors may fail to perform well for a number of reasons. Stress related problems, depression and substance misuse are known to be commoner among doctors than other similar professional groups. One particular manifestation of poor performance has been described as “disruptive” behavior or unprofessional conduct. These are situations where physicians are unhelpful, rude, or even abusive. Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments. Safety and quality of patient care is dependent on teamwork and communication. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team. Below is a list of established organizations which provide assessment, intervention and monitoring of “disruptive physicians”: Program for Distressed Physicians (Vanderbilt University) The Center for Professional Health offers a three-day continuing medical education course (CME) to address the specific needs of physicians whose workplace behavior has become problematic. This course combines didactic presentations, role-play with focused feedback, group feedback from peers and colleagues, plus review of workplace/family complaints. Participants will receive training in alternative behaviors and explore cognitive distortions that relate to their problems. The course will focus on the problems identified by specific complaints. The solutions are reinforced by role-play, feedback, testing and group accountability. An appropriate referral to this course would follow an assessment and evaluation to rule out medical and psychiatric problems. Contact William Swiggart for details. The three-day Continuing Medical Education course follows an assessment. The course fee is $4000, which includes three follow-up group sessions with course participants facilitated by course faculty. There is no discount for missed follow-up group sessions. Vanderbilt University School of Medicine is accredited by the Accreditation Council for CME to sponsor continuing medical education for physicians. The Vanderbilt School of Medicine Division of Continuing Medical Education will award up to 48 AMA PRA Category 1 Credit TM for the completion of the course, homework and all follow-up sessions. For more details and explanations of course material and assessments contact: William Swiggart, M.S., L.P.C. Training Director The Center for Professional Health 1107 Oxford House Nashville, TN 37232 - 4300 Tel: 615-936-0678 E-mail: [email protected] or [email protected] Web Site: www.mc.Vanderbilt.edu/cph Anger Management for Healthcare Professionals Program (UCSD) This course is designed to help those physicians and healthcare providers who have contributed to a disruptive working environment by way of inappropriate expression of anger. Conflict, stress and disruption in the hospital and clinic setting create low morale, heightened rates of staff turnover, and patient safety concerns. The Anger Management for Healthcare Professionals program is a small, (6-8 participants), intensive and highly interactive three day course taught by UCSD faculty from the Department of Psychiatry. Participant coursework in the form of self-reported inventories of mood and interpersonal conflict as well as reading is required. The objectives and goals of this course include: Aiding participants to identify triggers in the workplace leading to disruptive behavior. Didactic instruction providing constructive tools and strategies to aid in diffusing and managing anger and conflict in an appropriate and professional manner including: • Increasing Emotional Intelligence Empathy Training • Transforming conflict into cooperation. • Practicing both behavioral and cognitive strategies, including coping mechanisms, leading to healthier communication and interactions in the healthcare environment. • Developing a personalized plan of action (Commitment to Change) PACE provides a dynamic training program that offers professionals an opportunity to obtain educational information and personalized assessment in a highly sensitive, supportive and confidential environment away from the workplace. Participants who successfully complete the course receive 30.5 CME Category One credits. UCSD PACE Program 1899 McKee Street, Ste 126 San Diego, CA 92110 Email: [email protected] Executive Coaching/Anger Management for Disruptive Physicians™ In response to the need for a one on one individual and sensitive intervention coaching model for physicians, Anderson & Anderson is now offering a twelve-hour coaching program with 6 months of aftercare for “disruptive physicians”. This course is available at our Brentwood, California office or on-site seven days a week anywhere in the United States. The Anderson & Anderson Executive Coaching/Anger Management Program™ is listed in the Directory of Physician Assessment and Remedial Education Programs, Federation of State Medical Boards. No other anger management provider is authorized to use this model. Components of the course include: • One day, on-site observation (optional) • Comprehensive Emotional Intelligence Assessments are given at intake, focusing on the participant's level of functioning in managing stress, anger, communication and emotional intelligence. • We do not provide psychological testing, nor is our intervention considered counseling or psychotherapy. Therefore, there are no stigmas attached. • "The Practice of Control", the new Anderson & Anderson Physician client workbook, includes didactic information and exercises focusing on enhancing emotional intelligence, improving assertive communication, as well as behavioral strategies for recognizing and managing anger and stress. • Complimentary "Gaining Control of Ourselves" DVD along with follow-up kit. • "Styles of Communication" and "A Day Without Stress" are two power DVDs that are also complimentary. • Post-test at completion designed to determine the level of change during the course. • Bi-monthly follow-up sessions are provided for a six-month period when needed. Our services are provided with the utmost in confidentiality for all participants. Anderson & Anderson is the Preferred Provider for Kaiser Permanente Health Maintenance Organization of Southern California. For more information, call our office at 310-207-3591 now. Anderson & Anderson® Executive Coaching/Anger Management Program 12301 Wilshire Blvd. Suite 418 Los Ángeles, CA. 90025 Phone: 310-207-3591 www.andersonservices.com [email protected] Pinegrove Professional Enhancement Program 2255 Broadway Drive Hattiesburg , MS 39402 Contact: Greg Phillips (800) 301-6693 www.pinegrovetreatment.com Elmhurst Memorial Healthcare Professionals at Risk Treatment Services 360 W. Butterfield Road Suite 340 Elmhurst, IL 60126 Contact: Mary Pittman (630) 758-5110 www.emhc.org The Professional Renewal Center® is an international provider of behavioral health services and consultation for professionals striving to resolve work related challenges and personal dilemmas. Our central purpose is to objectively assess and treat disruptive behavior, professional sexual misconduct, boundary problems, career burnout, psychiatric illness, compulsive behavior, and substance related disorders. Our aim is to enable our clients to develop life plans that foster authenticity, personal growth, and professional integrity. More than 900 clients from 48 states in the United States, four Canadian provinces, and Hong Kong have come to the Professional Renewal Center® for assessment and treatment. Professional Renewal Center 1201 Wakarusa, Suite A-4 Lawrence, KS 66049 Contact: Kirsten Judd (877) 978-4772 www.prckansas.org Physicians Development Program 2000 South Dixie Highway., Suite 103 Miami, FL 33133 Contact: Larry Harmon, PhD (305) 285-8900www.physiciansdevelopmentprogram.com
The above post was actually written by me, George Anderson. I am not sure why I did not list my name.