Docs Gone Bad: Your top doc just threw a tantrum. Now what?

Otolaryngology leaders interviewed by ENT Today recommended a multi-step process to deal with disruptive physicians:

1. Establish a code of conduct. “You have to make clear what is acceptable and what is not, so no one can say they didn’t know,” Dr. Healy said. “Give examples of what you’re talking about, rather than some nebulous statement that ‘disruptive behavior will not be tolerated.’”
2. Ensure that leadership is willing to take on problem physicians. “They have to be willing to bring the person in and say, ‘We have a problem here. You throw instruments in the operating room. This will not be tolerated,’” Dr. Healy said.Harold C. Pillsbury, MD, FACS, chair of the Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina School of Medicine in Chapel Hill, said it’s important to let the physician know that others have noticed his or her disruptive behavior. “A lot of people will be nasty if they think no one’s watching,” Dr. Pillsbury said. “In such a case, senior staff must do a ‘360’ evaluation of that person, asking everybody in his world what they think of [the person’s] behavior. Then they provide that feedback to the individual.”
3. Set up a process for responding. Warn the disruptive physician, and refer that person to sources of help; then follow up to make sure that the behavior is changing, Dr. Healy advised.
4. Make finding help easy. Ensure that there are resources to help physicians in trouble without jeopardizing their careers. Dr. Whittemore pointed out that the Massachusetts Medical Society provides Physician Health Services, a program that was founded to deal with substance abuse but has more recently been successful in resolving behavior disorders. Physicians referred to the service aren’t required to be reported to the state licensing board. Dr. Whittemore also sometimes refers difficult physicians to an accredited life coach. “I’ve had two very successful turnarounds with successful senior rainmakers; with one, it wasn’t so successful,” he said.
5. Highlight the consequences of bad behavior. Dr. Levine advised leaders to follow a no tolerance policy for disruptive behavior. “If an individual is unwilling or incapable of change, despite academic success, their continued unacceptable behavior would mandate their dismissal,” he said.

Practice Settings

In the practice setting, response to such behavior must also come from the top, which can be more challenging depending on the size of the practice. Richard Waguespack, MD, FACS, who practices in Birmingham, Ala., can’t recall any egregious behaviors from colleagues in his specialty—“all otolaryngologists are very civilized,” he joked—but remembers a particularly ill-behaved orthopedist in his community.