• The empowerment of groups that previously suffered this behavior in silence certain that any complaint would be ignored or result in retribution. Many companies now, at the insistence of their insurance carriers, require "sensitivity training" that describes unacceptable behavior and the channels available to voice their grievances.
• Physicians who have perceived themselves as independent entrepreneurs now find themselves subject to scrutiny and control by multiple parties. These fearful, frustrated, angry physicians may act out more frequently than previously in the work place.
• Current rapid changes in the health care delivery system has stressed many physicians.
• Many physicians have grown up in an abusive environment at home. In medical school they may have been the object of physical, verbal and mental abuse. This behavior by their teachers and mentors has left an imprint upon them. Not only was this behavior tolerated previously but was seen as a mark of the abuser’s position and genius. Frequently this behavior was emulated by succeeding generations.
• Medical training has emphasized intellectual capacity at the expense of fostering and teaching interpersonal skills.

While it is difficult to precisely define "disruptive behavior," it is a chronic pattern of contentious, threatening, intractable, litigious behavior that deviates significantly from the cultural norm of the peer group, creating an atmosphere that interferes with the efficient functioning of the health care staff and the institution. The use of the word ’chronic’ in this definition implies a habitual pattern of behavior as opposed to the rare or occasional outburst on the part of the acutely fatigued or stressed physician, which is usually recognized even by the offending physician as exaggerated and inappropriate.

The disruptive physician often lacks the ability of self-observation. They view:

• Themselves as clinically superior (and they often are).
• Other members of the health care team as less competent or incompetent, weak and vulnerable.
• Themselves as champions for their patients (often the patients share this view).

Their disruptive behaviors are used either consciously or subconsciously to intimidate, control and blame others (for bad results). They are unable to perceive that the victims feel harassed, manipulated, controlled and abused. And their actions cause:

• A decrease in morale.
• Increase in the level of workplace stress.
• Inordinate time spent by staff appeasing or avoiding them.
• Increased risk for errors - communication breakdown that can result in delays and mistakes in making and implementing critical medical decisions. Often these errors then result in another and escalated round of inappropriate behavior.
• Increased potential for malpractice litigation.

When confronted with their behavior they frequently feel misunderstood and the object of envy and jealousy by others.

Not all disruptive physicians engage in these behaviors. Each behavior may have its own characteristics and require an individualized treatment plan.