Transcript Dealing With Doctors - A.T. Still University

SOMC Press
Dealing with
Difficult Doctors
Some Practical Strategies for Building
More Effective Nurse-Physician
Relationships1,2,3
A Presentation for the VHA Central Nursing
Leadership Institute
Kendall L. Stewart, M.D.
June 29, 2006
What’s in this for you?
• Doctors can be difficult.1
• Physicians are perceived as
so intimidating that hospital
CEOs often refuse to
schedule a talk with this
title.
• But you have to deal with
difficult doctors every day—
and you could probably use
some help.
• The line between annoying
and disruptive physicians is
not always clear.
• This presentation focuses on
annoying physicians
• After listening to this
presentation, you will be able
to
– Identify two common
difficult physician behaviors.
– Describe how those
behaviors “make” you feel.
– Explain how your feelings
cause you to behave.
– Specify two practical
strategies for building more
effective relationships with
physicians
– Explain why those strategies
make sense and how to
deploy them successfully.
Why is it so important that we learn
how to deal more effectively with doctors?
• Good relationships with doctors are critical to the
effective teamwork required in successful
healthcare organizations.
• Doctors enjoy enormous power.
• Physicians are bright, highly motivated (for the
most part), and we love to game systems.
• Physicians can be powerful allies or enemies.
• Doctors control most healthcare resources.
• Doctors can be difficult; we are often regarded as
“barriers.”1,2,3
• Our relationships with physicians exert a huge
impact on our lives and our work.
What is the extent of this challenge?
• Preparing to Deal with
Difficult Doctors
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–
–
–
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Preparing Yourself
Preparing Physician Leaders
Preparing Executives
Preparing Managers
Preparing Employees
• Dealing with Annoying
Doctors
– The Negative Physician
– The Selfish Physician
– The Unreasonable
Physician1,2,3
– The Whining Physician
– The Disorganized Physician
– The Immature Physician
• Dealing with Disruptive
Doctors
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–
–
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The Angry Physician
The Abusive Physician
The Dishonest Physician
The Arrogant Physician
The Pot-Stirring Physician
• Dealing with Dangerous
Doctors
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–
–
–
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The Marginal Physician
The Impaired Physician
The Incompetent Physician
The Distracted Physician
The Overwhelmed Physician
What commonly-employed strategies
don’t work?
• Making up our minds to
recruit only nice doctors
• Hoping that the difficult
physicians will change
• Ruminating about how
miserable these physicians
are making our lives
• Blaming physician leaders for
not whipping their difficult
colleagues into shape1,2
• Faulting the executives for
not shooting them at dawn
What are some problematic physician
behaviors?1
•
•
•
•
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•
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Failure to explain
Rudeness
Disrespect
Condescension
Ordering instead of
requesting or consulting
Undermining other team
members
Blaming others publicly
Not listening or taking
colleagues seriously
Indulging in temper
outbursts
Failure to say, “Thank you”
How do physicians’ difficult behaviors
“make” us feel?1
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•
•
•
•
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•
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Hopeless
Resentful
Angry
Hurt
Discouraged
Frustrated
Helpless
Enraged
Unappreciated
Rejected
How do our bad feelings and flawed
attitudes “cause” us to behave?1
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•
•
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Withdraw
Nag
Argue
Give up
Explain talk behind
others’ backs
Ruminate
Gossip
Try harder to please
Plot revenge
What are some successful strategies for
dealing with difficult people?1
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•
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Label them.*
Neutralize them.
Describe them.
Predict them.
Inform them.
Involve them.
Ignore them.
Convert them.
Avoid them.
Expose them.
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Circumvent them.
Use them.
Persuade them.
Confront them.*
Rehabilitate them.
Discourage them.
Ridicule them.
Isolate them.
Punish them.
Extrude them.
Label them.
• Why should you?
– Acknowledges they are
different
– Recognizes their need to be
“managed,” not befriended
– Initiates the management
process
– Minimizes your unrealistic
expectations
– Reminds you to become
emotionally detached
– Signals need to reach for
suitable tools
– Legitimizes others’
perceptions
– Forces you to take personal
responsibility
• How can you?
– Remain sensitive to your
own emotional arousal.
– Recognize the need to choke
off your emotional arousal.
– Imagine a sticky note
labeled, “A Real Nut”
attached to their foreheads.
– View them as impaired (they
are).
– Pity them.
– Concentrate on observing
their behavior.
– Reflect on why someone
might behave so
unproductively—as a
distraction, not as their
therapist.1,2,3
Confront them.
• Why should you?
– Challenges others’ tolerance
– Worries those who collude
with misbehavers
– Disrupts usual response
patterns
– Signals who’s in charge
– Provides relief from feelings
of helplessness
– Gives prior victims hope
– Reaffirms your commitment
to organization’s stated
values
– Encourages others to take
the same vigorous action1
• How can you?
– Document their behavior.
– Ignore suspected motives,
but record behavior in
descriptive detail.
– Focus on patterns instead of
isolated occurrences.
– Line up witnesses.
– Give emotions time to
dissipate.
– Nail down the support you
need.
– Confront in love and respect.
– Refuse to be distracted.
– Attach consequences and
describe next steps.
– Deliver on your promises.
What practical conclusions can
you draw from this talk?
• More effective teamwork with physicians is
essential to our organizational success.
• Our relationships with physicians and each other
can be improved.
• Building effective relationships demands a
considerable investment.
• We must focus on our own—not others’—attitudes
and behaviors since we have no control over theirs.
• Total success is not possible.
• Incremental success is easily achievable.
• This is a process, not an occasion.
• Improved teamwork is an important key to
increasing job satisfaction.1,2
Where can you learn more?
•
Stewart, Kendall L., et. al. A Portable Mentor for
Organizational Leaders, SOMCPress, 2003 S
Stewart, Kendall L., “Physician Traps: Some
•
July 24, 2002
Stewart, Kendall L. et. al, “On Being Successful at
•
SOMCPress, January 2001
Stewart, Kendall L., “Bigwigs Behaving Badly:
•
SOMCPress, March 11, 2002
Stewart, Kendall L., “Relationships: Building and
•
Practical Ways to Avoid Becoming a Miserable
Doctor” A SOMCPress White Paper, SOMCPress,
SOMC: Some Practical Guidelines for New
Physicians” A SOMCPress White Paper,
Understanding and Coping with Notable
Misbehavior” A SOMCPress White Paper,
Sustaining the Interpersonal Foundations of
Organizational Success” A SOMCPress White
Paper, SOMCPress, March 11, 2002
Please visit www.KendallLStewartMD.com to download related White Papers and presentations.
How can you contact me?
Kendall L. Stewart, M.D.
VPMA and Chief Medical Officer
Southern Ohio Medical Center
President & CEO
The SOMC Medical Care Foundation, Inc.
1805 27th Street
Portsmouth, Ohio 45662
740.356.8153
[email protected]
[email protected]
www.somc.org
www.KendallLStewartMD.com
Are there other questions?
www.somc.org
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