You Might Be A Disruptive Physician If... Avoiding the Disruptive Physician Label
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
I have never read a Jeff Foxworthy book, and I have never watched more than a minute or two of one of his comedy routines, so my apologies to him in advance.
However, I find his comedy routine about rednecks (or what I know of the little bit I have heard) to be a good vehicle for conveying what might be a joke to many, but should be taken very seriously, especially by one accused of being a disruptive physician.
In my decades of representing physicians, I have encountered cases where false complaints have been generated by the economic competitor of a physician with the medical staff of a hospital, in order to eliminate his competition. I have experienced cases where administrative personnel and nursing staff have conspired to generate complaints against a physician who was too demanding and unpopular with the nurses. I have seen unjustified complaints encouraged against physicians who have demanded only quality treatment for their patients. So it does not surprise me when I am consulted by a physician who claims he or she is the subject of trumped up and unjustified complaints, especially those as subjective as being "disruptive."
Unfortunately, identifying and eliminating the disruptive physician has become a recent goal of many hospitals. This has become a "hot button" among hospital administrators, medical staff leaders and credentials committees.
Being proven to be a "disruptive physician" may lead to adverse action against clinical privileges (resulting in a National Practitioner Data Bank (NPDB) report), action to drop the physician from insurance panels, adverse action by the state medical board, loss of specialty certification, and other consequences.
Types of Conduct That Might Make You a "Disruptive Physician."
According to reported cases and our experience in these matters, you might be labeled a disruptive physician if:
1. You use profanity in the work place.
2. You "yell at" or raise your voice to a nurse.
3. You threaten a hospital employee with having him or her fired.
4. You berate or "put down" a nurse or other staff.
5. You insinuate that a hospital employee is stupid.
6. You throw anything, anywhere in the presence of anybody, in the hospital.
7. You slam down anything (chart, coffee cup, lid to photocopier, etc.), anywhere in the presence of anybody, in the hospital.
8. You knock over anything (gumball machine, lamp, computer, etc.), anywhere in the presence of anybody, in the hospital.
9. You refer to anyone else as fat, stupid, lazy, "dumb blondes" or any other demeaning label.
10. You make sexually suggestive (or sexually explicit) comments and remarks in the presence of anybody else, anywhere in the hospital.
11. If you break anything (including the glass on the photocopier, the television in the doctors' lounge, etc.).
12. If you threaten a hospital employee with filing an incident report against him or her.
13. If you pull down the television set off of the wall in the waiting room and throw it down on the floor breaking it.
14. If you push a gurney into someone else in the hospital knocking her or him down.
15. If you "accidentally" drop a scalpel and it sticks into the foot of the scrub nurse in the operating room.
16. If you accidentally kick a bucket of bloody lap pads and it "accidentally" hits the nurse in the head and cuts her head open in the operating room.
17. If you are an on-call physician and you yell at the nurse on duty when he calls you at home and wakes you up at 4:00 a.m., and tell him not to call you again.
18. If you go to a nurse's supervisor and complain that the nurse is incompetent and should be removed.
19. You throw a surgical instrument "in the direction of" an operating room nurse because she handed you the wrong one.
20. You let it be known that you refuse to refer patients to another medical staff member because you consider him or her to be incompetent.
21. You tell sexually suggestive, racist, discriminatory or off-color jokes in the presence of anyone else, anywhere, at anytime in the hospital.
22. You refuse to work with nurses or technicians on the hospital staff because they are incompetent.
23. You refuse to follow established hospital protocols, policies or procedures, whether written or informal, because you don't have to.
24. When you are confronted with a mistake, a bad outcome, a complaint by staff against you or a request for input on a peer review of one of your patients, you blame the person making the complaint or report, and point out the shortcomings and lack of skill of others on the staff.
25. Physically threatening or merely intimidating others, including by insinuating that something bad might befall them.
26. Bullying or attempting to bully or intimidate others.
27. Passive aggressive conduct like refusing to attend mandatory department meetings, refusing to complete charts, refusing to respond to phone calls and pages, refusing to answer questions of others refusing to complete forms and reports, advising that it is not your job or that you are not on call any longer.
28. Retaliate against any other physician or hospital staff member who has reported you for violation of the code of conduct or for investigation of an incident.
29. Making negative or derogatory comments about other physicians or hospital staff members in front of any other person, at anytime, anywhere in the hospital.
30. Telling nurses, other staff members or patients that you don't care or don't want to hear what they have to say.
For other examples and a policy statement regarding disruptive physicians, see this Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG).
Consequences of Disruptive Physician Behavior.
According to one article on the subject by a physician leader, the consequences of disruptive behavior by a physician in a hospital are as follows:
Disruptive physicians undermine morale, diminish productivity and quality of patient care, and cause work environment distress leading to heightened employee turnover. One survey found that most nurses believe physician disruptive behavior causes stress, frustration, impaired concentration, reduced collaboration and communication, and potentially negative patient outcomes. Another survey found that nurses see a direct link between physician disruptive behavior and nurse satisfaction, retention, and the quality of the nurse-physician relationship. Other consequences of disruptive physician behavior include disciplinary actions, dysfunctional physician colleague activities (e.g., coverage, leadership, peer review, referral, etc), and compromised communication within and efficiency of healthcare teams. (References omitted.)
To see the entire article, click here.
"Disruptive Conduct" by the Physician Will be Linked to Patient Safety.
Hospitals and medical staffs are being inculcated with the idea that "disruptive behavior" by a physician undermines patient safety and is a risk to patient care. This will be the basis to support action against a physician's medical staff membership and clinical privileges in a privileging action by the medical staff. It will also be relied upon by the state medical board if a complaint is filed against the physician's medical license. It will also be the basis of upholding a legal challenge if the physician challenges the medical staff action in court. The courts will usually defer to the medical staff of the hospital in such matters and not want to overturn its decision.
If you want to see what hospital and physician executives think about disruptive physicians and how to deal with them, click on this article.
What to Do and Not Do.
Know what is considered to be conduct that exemplifies a "disruptive physician." Avoid outbursts of anger; they may make you feel better in the short run, but in the long run, you are hurting yourself. Hold your tongue. Avoid sayings anything that one could take offense to. If you are so weak willed that you cannot control yourself, maybe you do have a problem.
No one lives in a glass house, but pretend you do. Always think that someone can overhear or oversee what you do or say in the hospital. Everyone is human; everyone has shortcomings, even you. If you become known as a disruptive physician, everyone will be looking for anything you do wrong, and they will find it.
If you receive any complaints or reports insinuating that you are being tagged as a disruptive physician, whether it is informal counseling by a colleague or a formal warning in writing, take immediate actions to address the concerns. This may include, for example:
1. Educating yourself about the issue with the articles that appear on the internet.
2. Seek professional counseling; maybe you do have too much stress or an anger management problem.
3. Seek assistance from an experienced health attorney; you may be being set up for subsequent adverse clinical privileging action.
4. Avoid every type of conduct listed above.
5. Respond to the complaint or counseling, but do so with your attorney. You must keep an even, objective, neutral, non-accusatory tone to your response and not attempt to point a finger at others. Avoid the temptation to do so.
6. Read our other blogs and articles on this on our website.
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.
Disclaimer: Please note that this article represents our opinions based on our many years of practice and experience in this area of health law. You may have a different opinion; you are welcome to it. This one is mine. This article is for informational purposes only; it is not legal advice.
Tag Words: physician, doctor, discipline, physician complaint, physician report, disruptive behavior, doctor complaint, disruptive physician