Disruptive behavior can be caused by many internal and external factors. Troubled physicians could have mental health or substance abuse issues or be working through domestic issues with a spouse, children, or aging parents. There could be dissatisfaction with a practice's business or philosophical differences with the way care is delivered. Sometimes, people simply don't work well together.
Unfortunately, if the intervention isn't done correctly, it could create more trouble and the offending physician could make a counter claim for racial, gender, or disability discrimination.
It's not enough simply to have a firm set of rules. "Rules are what we fall back on when things aren't going well," says Scott A. Fields, MD, professor and vice chair of family medicine and COO at Oregon Health & Science University in Portland. "If you are only talking to a doctor when they are in trouble, it creates a bad environment, and so having regularly scheduled opportunities for feedback that can be positive and critical is important. It's better to reinforce what is right instead of what is wrong."
Fields says physicians must get over their reluctance to report abusive behavior by colleagues. "Physicians think of a culture of the physician as a single entity, a box within themselves in terms of their operations. They [feel they] are responsible for their box only and another physician is outside of their box," he says. "Unfortunately, that leaves managers of practices as oftentimes the ones who have to deal with this, and probably inappropriately so."
If, despite your best efforts, there is a workplace incident, document it thoroughly. "A key downfall is physicians never make any notes," says Susan Reynolds, MD, president and CEO of the Institute for Medical Leadership in Pacific Palisades, CA. "They don't like doing personnel management or review. When there is an incident, very little is written up. So when you want to do something once this person is shown to have bad behavior, you may not have a trail that shows a pattern of bad behavior. Every person has lost their temper at one time or another, but if this is a pattern that needs to be dealt with, it is important to have a paper trail and document things."
Get a signature for every document to avoid potential litigation, says J. Peter Rich, JD, partner at McDermott Will & Emery, LLP, in Los Angeles.
"It should be documented, dated, and signed," he says. "The language should not indicate bias or opinions of a psychiatric nature, but it should document exactly what happened based upon interviews with the people who observed it, and then the physician or other personnel should sign it. The physicians involved should sign it, and that should be part of their personnel file for the doctor so later, if you've got to make a case, you've got it there. If it involves counseling, the physician who is the subject of the counseling should sign it as well. If there is an agreement for the physician to change his behavior as a condition of continuing with the group, that should be in writing and signed."
This article was adapted from one that originally appeared in the September issue of The Doctor's Office, a HealthLeaders Media publication.