Are Disruptive Physicians a Real Problem -- or Scapegoats?

Neil Chesanow


October 20, 2015

Petty, Dangerous, Disruptive Doctors: Watch Out!

The topic of "disruptive doctors" evoked strong feelings from readers on both sides—from physicians who sadly recalled bad experiences with difficult physicians and from those who maintained that too many doctors were inaccurately labeled as "disruptive," creating a pointless increase in sham peer-review cases and inappropriate disciplinary actions.

"The impact of disruptive doctors is more serious than just hurt feelings," a recent Medscape article pointed out. "Intimidating and abusive behavior leads colleagues and nurses to avoid that doctor and hesitate to make suggestions about patient care." The article went on to discuss the ways in which physicians may be disruptive and how such behavior is most effectively addressed.

One practice management consultant said that he had seen "doctors striking patients, destroying hospital property, stalking nurses, surfing the Web for porn while at the hospital, shouting profanities at staffers, you name it." An older surgeon was performing unnecessary surgeries, another consultant recalled, while his colleagues kept mum. Another doctor was persistently late in doing his charts. His incomplete charting was costing his practice $20,000 a month.

The problem of "problem" doctors "is more extensive than many realize," the article maintained, "and has far-reaching impact on patient safety, staff retention, a group's or hospital's malpractice liability risk, and the organization's financial bottom line." In one study cited by the article, over 70% of participating physicians reported that disruptive physician behavior occurred at least once a month in their organizations, and more than 10% say such incidents occur daily.

The reason disruptive physicians are allowed to continue unchecked, the article contended, is that their colleagues hesitate to say anything. "Independence is so highly valued that physicians are loath to evaluate or confront a colleague whom they perceive as having a problem," one expert observed.

The article focused on remedial measures. For example, group practices and hospitals should develop a code of conduct that defines expected behavior, including what will be tolerated and what won't be. Physician leaders should initially approach the problem doctor in an informal setting, usually over a cup of coffee. An example of how to initiate the conversation might be, "How's it going? There's a troubling pattern that we're concerned about. Can you help us understand it better? How can we help change it?" This gives the doctor some options, and he doesn't feel like he's being attacked. The emphasis was on constructive intervention and rehabilitation, not immediate termination.

The article sparked well over 100 impassioned comments. Many physicians saw the problem of problem doctors from a variety of perspectives.

"I clearly remember one doctor during my residency," a physician wrote. "This man was unfailingly polite to me. However, he often spoke openly in surgery about the 'fat cow' he was working on (while removing a breast), and I once saw him roughly shoving a patient's newly operated on remaining breast tissue around in a hateful, deliberately rough way while muttering epithets. Yet when she was awake, he acted all nice and concerned. There was always dead silence among the women in the OR when he did things like this. He was also a curser and instrument thrower. I lacked the courage to call him out on his behavior."

"Most of these problems with off-the-wall doctors can't be addressed by simple formal/informal conversation," a family physician maintained. "These folks who are abusive both at home and at work are actually crazy in the original sense of the word. You can have all the conversation you want, but if a physician has a personality disorder or bipolar disorder, the only way to correct it is by using industrial-strength mood stabilizers in conjunction with behavior therapy. Most importantly, the group has to find a way to terminate such a physician ASAP. These crazy doctors attract lawsuits and lawyers like sugar attracts ants. The accompanying headache is not going to be worth it."

"I have seen this and been a victim of this through medical school, residency, and the workplace," another family doctor commented. "These bullies are even worse toward female physicians. Hospitals, medical schools, and residency programs should not tolerate this behavior. I have seen firsthand where patient safety and care were compromised by allowing this to go on."

Some "disruptive physicians" wrote in to defend their actions. "I was reported for being 'disruptive,'" a surgeon admitted. "I had a patient crashing on the table as anesthesia tried to get an airway. When I grabbed the sterile gloves out of the hand of the OR nurse, she took offense and proceeded to berate me for being rude. After I got the cricothyrotomy done, I yelled at her for being an idiot. I, not her, was apparently in the wrong for being unprofessional. The young woman ended up dying from severe anoxic brain injury."

"I have an extremely busy practice," another surgeon explained. "In my office, as I'm sure is the case with many other surgeons, we are overbooked because all the PCPs want their patients to have immediate access. These same PCPs are in the administration of our group and come up with increasingly more stringent demands for getting charts done. I cannot see a double-booked schedule full of patients and do all the charts in the time prescribed. When I was supplied a PA, my charts were done. So now I suppose I would be a 'problem doctor' because I'm chronically behind on my charts—one of the examples cited in the article—but the administration in my practice refuses to get me the help I need."

"The definition of 'disruptive physician' is so broad that virtually all physicians fit the profile, leading to a gross increase in sham peer-review cases at many hospitals," a cardiologist asserted. "The small percentage of doctors who are truly disruptive can be referred for mental health evaluation and their careers saved. Early intervention is important."

"Labeling a physician 'disruptive' is now the number-one weapon for driving out physicians who may compete monetarily or who themselves question the conduct or professionalism of an organization or entrenched or senior individual," a geriatrician contended. "Such labeling may also be used to carry out vendettas for obscure motivation."

"The notion of 'disruptive physician' is a label used to threaten and intimidate physicians who don't agree with whatever hospital administrators and nurse managers want to impose on us," a pain management specialist observed. "This is part of a power grab that must be resisted for the sake of our autonomy. Of course, you are by definition disruptive if you speak out against these things."

"Evaluation of disruptive behavior is a form of professional peer review," an emergency physician agreed. "Such activity has to be performed on a level playing field, and all physicians should be held to the same ethical standards for performance. Disruptive behavior by a physician who generates high revenue for a hospital generally gets a pass, even for such activities as sexual harassment, sexual assault, or drug abuse, because of corporate concerns over financial losses or bad publicity. On the other hand, physicians who treat complex and high-risk patients may not be as cost-efficient and are frequently targeted by insurance carriers or hospitals for exclusion."

For some commenters, being branded "disruptive" wasn't necessarily a bad thing. "Disruptive behavior is positive," a pulmonologist argued. "Question the norm," he urged. "If you can't accept and learn from the unusual, then you should examine your own professional philosophy. Many doctors have disabling personalities. It goes with intelligence."


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