Who or what is a disruptive physician?

The disruptive physician typically exhibits a pattern of behavior characterized by one or more of the following actions:

• Employs threatening or abusive language, directed at nurses, hospital personnel, or other physicians (e.g. belittling, berating, and/or threatening another individual)
• Makes degrading or demeaning comments regarding patients, families, nurses, physicians, hospital personnel, or the hospital
• Uses profanity or other grossly offensive language while in a professional setting
• Utilizes threatening or intimidating physical contact
• Makes public derogatory comments about the quality of care being provided by other physicians, nursing personnel, or the hospital
• Writes inappropriate medical records entries concerning the quality of care being provided by the hospital or any other individual
• Imposes idiosyncratic requirements on ancillary staff which have nothing to do with better patient care, but serve only to burden staff with "special" techniques and procedures

Note that we are talking about a pattern of behavior that may or may not overlap a psychiatric diagnosis and/or other impairment such as chemical dependence, major depression or personality disorder. The presence or absence of a diagnosis is important for many reasons, including the ability of NCPHP to help; this will be discussed later. The presence of a pattern is also very important. NCPHP usually does not (and generally should not) receive referrals for an isolated incident or very minor instances of disruptive behavior.

When can NCPHP be of help?

NCPHP is usually able to help the physician/PA and the referring agency when all of the following are true:

• A pattern of behavior has been established and documented. The pattern should be clearly documented with examples and consequences to the hospital or clinic. The examples can be used to explore the problem with the physician or PA and look for underlying triggers and issues that can be addressed. Typically, the clinician has little or no insight into the effect he or she has on others, or how often the behavior has been a problem. They are focused on clinical and/or systems issues that are often very real and significant, but they are approaching these issues in a destructive and unhealthy way. If NCPHP has no documentation of specific instances of disruptive behavior, it is difficult to help the physician develop any insight into his/her effect on others.
• There is a treatable condition. NCPHP is primarily set up to assist with actual or potential impairment. The prognosis is actually best for physicians or PAs with a well-defined Axis I diagnosis such as depression, bipolar disorder, or chemical dependence. Axis II personality disorders, such as narcissistic or obsessive-compulsive, often require very long-term treatment, and the prognosis varies greatly. The prognosis for those simply prone to angry outbursts (“impulse-control disorders”) also varies greatly and may depend largely on potential consequences.
• The physician/PA is willing to take some responsibility for his behavior and acknowledge that he is at least part of the problem. Rarely will the referred individual take total responsibility for the whole conflict or problem; in many cases this may not even be appropriate. But if the individual is willing to look at his own behavior to some degree, NCPHP can work with him to build on this foundation. If, on the other hand, he is unwilling or unable to look at himself at all, NCPHP is not likely to be of much help.
• The referral is presented and intended as being for help rather than punishment. NCPHP has no ability or authority to punish "bad behavior”, nor is that our purpose. Some physicians/PAs will view the referral as punitive no matter how it is presented; however, a referral to NCPHP reflecting a positive, cooperative note will increase the chances of a good outcome. This tone should be also be taken in the hospital or clinic’s policy on handling of disruptive behavior.
• The referring agency is willing and able to impose consequences if the behavior does not change. NCPHP sometimes gets referrals of physicians or PAs who have been given "umpteen chances" to correct a problem. NCPHP will always help the doc or PA look at underlying causes of behavior and ideally they will make changes before consequences occur. But the needs of the referring source and the physician/PA are best served if there are clear limits and consequences established and enforced.

Obviously, the circumstances listed above represent the ideal situation, and that will not always occur. However, the more factors that exist or that can be promoted, the better the anticipated outcome.