You May Be a "Disruptive Physician" If . . . Take this Quick and Easy Quiz to See If You Might Be a "Disruptive Physician"

Tuesday, February 4, 2020

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

I often have consultations with and represent physicians from across the country who are in trouble with their hospital medical staff or their licensing board because a complaint has been filed against them alleging they are a "disruptive physician." This is often the result of an alienated member of the nursing staff or even an economic competitor trying to make trouble for or get rid of the physician.

A disruptive physician is one whose "obnoxious" behavior upsets patients or other staff members. The American Medical Association defines this in its Code of Medical Ethics as "personal conduct, whether verbal or physical, that negatively affects or that potentially may affect patient care." This type of behavior is disfavored in hospitals and health systems because it is thought to negatively affect patient care by decreasing morale, teamwork, collaboration and communication among health professionals.

The Joint Commission Gets Involved.

Starting in 2008 the Joint Commission began urging hospitals to incorporate provisions to rein in disruptive behavior in the hospitals by physicians. The Joint Commission started requiring hospitals in 2009 to have a written code of conduct addressing the issue. This code of conduct must define acceptable, disruptive, and unacceptable behavior in the workplace, the latter two of which are usually lumped together.

Take This Quiz to See if You Are a "Disruptive Physician."

Having represented physicians in hearings before medical staff peer review committees, resident physicians before academic conduct committees and appeal review committees, and physicians in hearings before the board of medicine, I have put together the following quiz from the types of misconduct such bodies use to denote a "disruptive physician."

DISRUPTIVE PHYSICIAN QUIZ

Check "Yes" or "No" for each statement or question. Each "Yes" answer counts for one (1) point.

	QUESTION / STATEMENT	Yes	No
1.	I am a perfectionist.
2.	I expect nursing staff to be competent and qualified to do their jobs and I let them know this.
3.	My patients tend to be the sickest patients around.
4.	I take patients no other physician in my specialty will take.
5.	I have a low tolerance for mistakes when it comes to patient care.
6.	I may have occasionally slipped and used profanity in a conversation with a nurse or staff member.
7.	I may have used profanity in a conversation with another physician.
8.	I refer to the staff as "the girls" but that's only because they are all female and I'm so much older than they are that they look young to me.
9.	I have lost my temper and raised my voice to a nurse before.
10.	I have never thrown an object at a nurse or staff member before, but I have thrown an object in the presence of a nurse or staff member.
11.	I have thrown an object at a nurse or staff member before.
12.	I have referred to a nurse or staff member as "Blondie" before, but only because he or she had blonde hair.
13.	I have told an off-color joke before in the presence of other physicians staff or nurses.
14.	I have told a racist joke before in the presence of other physicians staff or nurses.
15.	I have lost my patience when surgery or a procedure has been delayed.
16.	I have slammed down a chart or papers at the nurse's station before.
17.	I have criticized a nurse or staff member so severely that he or she has cried before.
18.	I have thrown an object in the surgery or procedure room.
19.	I have made negative comments about a nurse, staff or another physician to a patient before.
20.	I like to hug nurses and staff members and do hug them.
21.	Nurses and staff members know I like to hug and they like to be hugged by me.
22.	I take longer than others to complete my medical record entries.
23.	I have filed an incident report or complaint about a nurse, staff member or other physicians.
24.	One or more nurses are out to get me.
25.	One or more nurses fear me and rightfully so.
26.	I have received, been required to sign a performance or behavioral contract by my hospital or medical group.
27.	I am the best physician in the hospital.
28.	I have accidentally broken a coffee mug, instrument, appliance, or something else in a fit of anger.
29.	The nursing staff doesn't like me because I expect more from them.
30.	I often make others feel stupid, but that is just because I am so smart.
	TOTAL ANSWERS:

Add up all your "yes" answers above and see where you fall on the following chart:

SCORE
0 to 1	You are not a disruptive physician. You may be dead, however.
2 to 32	You may be a disruptive physician.

Although the quiz above is tongue-in-cheek, all of the questions or statements on it come from actual cases where a physician had to defend himself or herself against charges that they were a "disruptive physician."

Legal Defenses To Disruptive Physician Charges.

Allegations against a physician for "disruptive behavior" are often vague and impossible to properly defend. It is imperative that if such charges are made against you, you obtain legal counsel who can get involved right away. Such vague, subjective allegations often are relatively easy to defend against, when the true facts are ascertained.

In the case of Fahlen v. Sutter Central Valley Hosp., 58 Cal. 4th 655 (2014), the physician’s hospital clinical privileges were terminated because of a claim of disruptive behavior. The California Supreme Court reversed the hospital's decision and allowed the physician the right to proceed with a whistleblower case alleging substandard nursing care by the hospital's nursing staff and the presence of risk to patient safety. In effect, the Court ruled that the doctor was merely a valid whistleblower complaining about quality of care issues. There are similar cases from other jurisdictions.

One can defend such a case by showing that the doctor's actions are objectively reasonable under the circumstances. Other times you may have a defense you can show because an economic competitor is filing complaints or causing them to be filed against you. Sometimes complaints are generated by hospital staff as a result of a physician's complaining about incompetent nursing staff or lack of proper equipment. In some cases, we have seen a single nurse generate enough animosity towards a physician so as to have charged with being disruptive.

Read one of my past blogs titled, "Disruptive Physicians: Nobody Likes a Nuisance" to learn more about this topic.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in accusations of disruptive behavior, Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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2/4/2020