In FOX’s hit medical drama “House,” the lead character, played by actor Hugh Laurie, is a diagnostic genius who has saved untold live—but is also a miserable human being who makes life difficult for his patients and co-workers alike.
In the “real world,” disruptive physicians like Dr. House are all too easy to recognize. They’re the ones who:
- Bully, intimidate and demean nurses and other staff
- Show disrespect to co-workers and patients
- Have verbal outbursts that include yelling, insults or other abuse
- Make physical threats or throw items at others
- Refuse to complete tasks or carry out orders-either passively or deliberately
- Engage in sexual misconduct and other inappropriate behavior or language
- Write inappropriate chart notes
- Exhibit dishonest or unethical behavior
- Retaliate against those who make complaints
When such a doctor is a “resident genius” whose lifesaving skills have garnered patients, revenue and acclaim to your organization, there’s been a tendency to look the other way.
SILENCE IS EXPENSIVE
While such behavior may be entertaining on TV, it has damaging consequences in the real world, according to Dr. Alan Rosenstein, medical director for VITAL WorkLife. that designs counseling and intervention programs for hospitals and medical organizations.
“A growing body of scientific literature suggests that problem docs not only threaten patient safety, but expose hospitals to malpractice lawsuits and staff shortages, especially nurses bullied out of their jobs by intimidating physicians,” says Rosenstein.
Even if the vast majority of doctors behave responsibly, disruptive behavior by even one or two physicians in your organization can cause untold damage. Research done by Vanderbilt University Medical Center showed that 9% of physicians accounted for 50% of unsolicited patient complaints-and over 50% of malpractice dollars paid out over the study period.
WHAT CAUSES DISRUPTIVE BEHAVIOR?
According to Dr. Rosenstein, a national expert on disruptive physician behavior who has published several articles on the issue, the problem with problem docs stems from the unique, unforgiving culture of the medical schools where they’re trained.
“Med students are first ‘broken down’ and told they know nothing, which produces low self esteem and confidence,” says Rosenstein. “Then they’re thrust into a situation where they’re expected to work autonomously and autocratically.”
As a result, physicians develop big egos that defy any scrutiny of their performance or competence. “Throw in long hours, the emotional toll of treating patients and doctors start to suffer from stress and depression, failed marriages and even alcohol and drug abuse,” says Rosenstein. “They start to lash out at nurses and other staff, which jeopardizes patient safety because the two groups either won’t or can’t communicate with each other.”
These personality traits are compounded by an overall reluctance to seek help and a fear of losing everything from the respect of their colleagues to their licenses to practice medicine.
A PROBLEM ACROSS THE INDUSTRY
The problem is not only prevalent—there’s an industry move to address it as evidenced by the Sentinel Alert issued by the Joint Commission that became effective January, 2009.
Hospitals are now required to address disruptive and inappropriate behaviors in order to receive and maintain accreditation. In order to minimize the risk of adverse events and malpractice suits, medical groups must also have the awareness and skill set to intervene effectively when a colleague or employee first begins behaving unprofessionally.
EARLY AND EFFECTIVE INTERVENTION
Founded in early 2009, VITAL WorkLife boasts hospital and medical group clients across the country who are using our services to treat problem doctors struggling with stress, substance abuse and depression—and to prevent future problems from occurring.
“In most cases where intervention is required, the first step is to get the physician to recognize that a problem even exists,” explains Rosenstein. “Most of the time physicians don’t perceive that they’re working under any undue stress, and even if they do, they look at stress as being part of the job.”
VITAL WorkLife offers escalating levels of intervention which give organizations the flexibility to deal compassionately and effectively with everything from one-time, less-serious or emerging behaviors of concern (where physicians are often given an opportunity to self-correct) to disciplinary interventions around serious incidents or continuing patterns of disruptive behavior.
PREVENTATIVE MEDICINE
While early intervention is desirable, preventing problems from occurring in the first place is even better. VITAL WorkLife offers a Physician Wellness Resource program that provides counseling services from physician peer coaches and master’s- and doctorate-level mental and behavioral health specialists, along with a broad array of concierge and online self-service work and life resources designed to make life less stressful for physicians and their families.
“VITAL WorkLife counseling services are uniquely designed to address the barriers that typically prevent physicians from getting the help they need, such as lack of time, fear of stigma and an inability to find or use ‘peers’ for confidential support and coaching,” says Rosenstein.
On top of The Physician Wellness Resources, VITAL WorkLife offers training and consulting that help organization leaders, physicians and their co-workers address issues that affect their well-being—on and off the job.
“The first question should always be ‘What can we do to prevent this?’” notes Rosenstein. “Punitive measures should be a last resort.”
We Can Help
For more information on how VITAL WorkLife can help you prevent and address problems associated with disruptive physicians, contact us, or click here to learn more about our Physician Intervention program!
