Transcript The Anxiety Disorders Some Practical Questions & Answers

Doctors
Behaving
Badly
Some Practical Strategies for
Dealing with Disruptive Physicians
A Presentation for Holzer Medical Center
Kendall L. Stewart, M.D.
April 19, 2005
Why is this important?
• People are often difficult.
• Bigwigs are particularly
difficult.
• Doctors
– Are the biggest wigs in the
hospital,
– Sometimes behave badly, and
– When they do, it causes real
problems—including problems
with morale and retention.
• Judging from all the attention
this topic receives, we must not
manage difficult doctors very
well.
• We could do better.
• And after this presentation, we
will.
• After mastering the information
in this presentation, you will be
able to
– Identify three categories of
difficult physician behavior
– Describe three practical
strategies for dealing with
disruptive physicians,
– Explain why those strategies
make sense, and
– Explain how to deploy these
strategies successfully in your
organization.
• While only a minority of
physicians are truly difficult,
these bad actors consume the
bulk of the organization’s energy.
• That’s why this so important.
What are some of the categories of
difficult physician behavior?
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Annoying Doctors
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Disruptive Doctors
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Negative doctors
Selfish doctors
Unreasonable doctors
Whining doctors
Disorganized doctors
Immature doctors
Angry doctors
Abusive doctors
Dishonest doctors
Arrogant doctors
Felonious doctors
Dangerous Doctors
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Marginal doctors
Incompetent doctors
Impaired doctors
Distracted doctors
Careless doctors
Overwhelmed doctors
How do disruptive doctors behave?
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They are disrespectful.
They berate colleagues publicly.
They use abusive language.
They indulge in condescending
behaviors.
They throw temper tantrums.
They intimidate and threaten.
They engage in sexual harassment.
They lie, cheat and steal.
They are insulting.
They are upsetting to patients.
They throw things.
They slam doors and hit walls.
They may even physically assault
others.
What are some strategies for dealing
with disruptive physicians?
• Acknowledge the problem.
• Make a commitment to manage
the problem.
• Clarify your behavioral
expectations.
• Require physicians to agree to
behave.
• Field the best possible executive
team.*
• Recruit a strong physician
executive.
• Initiate a culture change.
• Delegate with care.
• Investigate and document
allegations promptly,
dispassionately and thoroughly.*
• Insist on fairness.
• Confront physicians effectively.
• Consider all options and choose
the best one(s).
• Propose a reasonable solution
and force dissenters to appear
unreasonable.*
• Inform medical staff leaders; do
not consult or seek consent.
• Follow up promptly with staff
members.
• Send resolution letters
immediately.
• Dismiss nuisance complaints
quickly.
• Give your stars the star
treatment.
Field the best possible
• Why should you?
– This is your first obligation to
your organization and your
community.
– These leaders set the tone.
– Managing disruptive
physicians effectively is not
possible without a strong
executive team in place.
– Lack of a unified team will
invite mischievous physicians
to “divide and conquer.”
– Weak leaders avoid conflict at
all costs.
– When they can’t avoid conflict,
they manage it badly.
executive team.
• How can you?
– First, ask yourself whether
you have fielded the best
possible team of leaders.
– If you haven’t done it, do it.
– When you have, ask your boss
to do the same.
– Offer your resignation as
evidence of your commitment.
– Persuade your colleagues to
take the same approach.
– Participate in meaningful
succession planning.
– If you are an executive, remind
the CEO that this is her
primary obligation to the
organization and the
community.
Investigate and document allegations
promptly, dispassionately and thoroughly.
• Why should you?
– The “facts” of these incidents
evaporate quickly.
– Everybody else’s emotional
arousal distorts their
perceptions.
– Your objectivity immediately
establishes you as one who can
be trusted.
– Your patient search for
understanding discourages the
leap to premature and erroneous
conclusions.
– Your willingness to take
meaningful action right away
establishes you as the scene
commander, reassures the
victims and troubles the
misbehavers.
• How can you?
– Interview witnesses right away.
– Include their manager in the
interview process.
– Encourage complainants to
prepare and sign their own
statements.
– Do not act on undocumented
hearsay; invective is usually
followed by profound memory
loss.
– Present the documentation to
the physician.
– Document the resulting
conversation.
– Invite the physician to respond
in writing.
– Retain everything in their
credentials files for two years.
Propose a reasonable solution and force
dissenters to appear unreasonable.
• Why should you?
– It’s your job.
– It’s fairly easy to do.
– But very few leaders in these
circumstances can figure this out.
– Most leaders are so emotionally
aroused in these situations that
they can’t see the available
options.
– When you offer to take charge of
this mess and the resulting fallout,
your grateful colleagues will get
behind you—way behind you—in a
heartbeat.
– Most leaders are paralyzed by fear
that someone won’t like them if
they take an unpopular stand.
– The emergence of a “reasonable”
option is just the exit door they
were seeking.
• How can you?
– Identify every available option.
– Present the available options to
the physician.
– Rule out the (unreasonable)
options the physician prefers
• firing the staff member who
annoyed him or
• just forgetting the whole
thing.
– Propose the most reasonable
option.
– Offer early adoption of this option
as an opportunity to close the book
and move on.
– If you’ve done your work properly,
they will usually take their licks
and move on.
– But they will remember and they
will be less inclined to touch this
hot stove again.
What have we learned?
• Disruptive physician behavior is a real problem in
most of our hospitals.
• Difficult people—including difficult physicians—are
here to stay.
• But the problem can be managed and minimized—and
it must be.
– Board commitment is critical.
– Effective senior leadership is essential.
– Strong physician leaders are the key change agents.
– The deployment of the strategies in this presentation will
make a difference.
Where can you learn more?
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•
Rosenstein, Alan H., et. al., “Disruptive Physician
Behavior Contributes to Nursing Shortage,” The
Physician Executive, November-December, 2002
Stewart, Kendall L., et. al. A Portable Mentor for
Organizational Leaders, SOMCPress, 2003
Stewart, Kendall L., “Physician Traps: Some
•
July 24, 2002
Stewart, Kendall L. et. al, “On Being Successful at
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SOMCPress, January 2001
Stewart, Kendall L., “Bigwigs Behaving Badly:
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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
Most of these White Papers can be downloaded from www.KendallLStewartMD.com.
How can we contact you?
Kendall L. Stewart, M.D.
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
What questions remain?
www.somc.org
Southern Ohio Medical Center
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