A code not only sets expectations for acceptable behavior but also details how exceptions to proper behavior will be handled, thereby helping the practice by ensuring that all incidents are handled similarly. Giving one physician great latitude while coming down hard on another opens up legal issues that are best addressed early. Likewise, in order to decrease the likelihood of successful claims of discrimination or personal animosity, decisions about enforcing consequences for inappropriate behavior should not be made by only one person, when possible.
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May 2016Document, Document, Document
“Documentation and follow-up is a very important part of the process,” said Leigh Olson, owner of Nova Consulting in Denver and co-creator of Master Series Seminars. “We find practices have rules and protocols, but there are no consequences when they are not followed. The rest of the office sees rules are not being followed and it sets a precedent, making it harder to enforce any of the rules.”
Many places offer information on how to set up employee codes of conduct, along with policies and procedures for handling breaches. Practice management associations, The Joint Commission, and the hospital with which your practice is affiliated can suggest ways to word these documents.
Although you can use a generic code for a starting point, Holmes recommends that the final product be written with input from each team member so that they have “buy in,” instead of having it imposed from on high, and that the code be vetted by an employment attorney before it is implemented.
Legal Considerations
Once a disruptive physician is identified, the first suggestion from a legal standpoint is to determine whether there is an underlying health or medical issue causing the behavior. If what is happening relates to depression, substance abuse, or another disability that falls under the purview of the Americans with Disabilities Act, there may be some obligation to provide a “reasonable accommodation” for treatment.
“If there is a possible disability issue, that would be a good time to get an employment attorney involved,” said Holmes. “This doesn’t mean that a practice must tolerate a physician who is using alcohol or drugs while working. In that situation, a zero tolerance policy would require immediate termination.”
A number of interventions must be considered. Give the physician an opportunity to discuss the complaints and tell his or her side of the story in a confidential process. “Frequently, the doctor doesn’t realize that his or her behavior is offensive or inappropriate,” said Dr. Sataloff. “Having someone point out the behaviors helps to make the doctor more aware of how his or her interactions affect others. When they are open to criticism and willing to change behaviors, this approach is usually successful and sufficient.”