Great Equalization: Is MBBS From India Equal To M.D. In U.S.A?

SPECIAL ARTICLE
AAPI Journal • March 2009
The Behaviorally Disruptive Physician
by Gopal Lalmalani, M.D.
Gopal Lalmalani, M.D.
Denver, Colorado
Some health care professionals may
consciously or subconsciously be
perpetrators of disruptive behavior in
our workplace. New JCAHO
standards require that hospital and
medical staff leaders recognize such
pattern of disruptive behavior and
confront these professionals. The Joint
Commission states that “safety and
quality thrive in an environment that
supports working in teams and
respecting other people, regardless of
their position in the organization.
Undesirable behaviors that intimidate
staff, decrease morale, and increase
staff turnover can threaten the safety
and quality of care” This new
standard will be applicable to
physicians as well as all other health
care professionals (including nurses,
pharmacists and management).
Who is a disruptive physician and
what is disruptive behavior? Although
there is no clear definition, the term
“disruptive” is sometimes used
interchangeably with the term
“abusive” and the AMA describes this
type of behavior as “a style of
interaction with physicians, hospital
personnel, patients, family members
or others that interferes with patient
care”. Disruptive behavior
encompasses a spectrum of conduct
that includes verbal abuse, emotional
outbursts, yelling and screaming, use
of sarcasm or belittling remarks, and
threats of violence. It may also
include incidents of inappropriate
physical contact, throwing tantrums,
and tossing objects. Other health
team members are likely to try and
avoid contact with the disruptive
physician which may then affect the
communication needed to provide
high quality patient care.
Disruptive physician policies are
often written vaguely and broadly,
and are subjective. As an
organization, we need to ensure that
these policies are not used to target
outspoken medical staff members or
physicians who are not “team
players”. We need to protect
competent and compassionate
physicians who truly care for the
patient’s welfare, and who provide
good-faith and constructive criticisms
in order to improve the quality of care
in the hospital. The AMA code states
that, “criticism that is offered in good
faith with the aim of improving
patient care should not be construed
as disruptive behavior”.
We need to also ensure that these
disruptive physician policies are not
targeted to get a physician off the
medical staff by an economic
competitor who for some reason or
the other may be more “influential”
within the hospital. There have been
instances where the hospital nursing
staff has been instructed to “write up”
every action of a “targeted” physician
as “inappropriate”. Such false labeling
of a targeted but innocent physician
could be a blow to his or her practice
resulting in loss of reputation in the
community and loss of income. Any
correspondence from the hospital or
medical staff leadership that
insinuates that a particular physician
may be “disruptive” should be taken
seriously and responded to
immediately with objectivity and
facts. If necessary, legal counsel from
a health law attorney should be
obtained. Otherwise, the potential for
loss of privileges, loss of liability
insurance, and termination of hospital
contract could be a real one.
Furthermore, reports to the state
professional health program, the state
licensure board, or the National
Practitioner Data Bank may further
jeopardize the physician’s career.
Medical staff leaders need to
carefully craft by-law provisions that
contain procedural safeguards that
protect due process, and offers fair
hearing. Physicians who truly exhibit
disruptive behavior should initially be
referred to a medical staff wellness
committee. The key is to get the
physician involved as soon as
possible. At times, requesting another
respected physician colleague to be a
liaison or a mentor could be useful in
calming a disruptive physician. If
disruptive acts recur, more formal
action is warranted. If the physician
behavior poses a significant risk to
patient safety, immediate suspension
of privileges may be necessary. If the
physician’s behavior does not pose an
imminent risk to patient safety, then a
meeting should be held by the
Medical Executive Committee, and a
formal peer review be initiated. Peer
review needs to be legitimate, with
the sole purpose of protecting patients
in furtherance of their quality of care
and promoting safety.
As physician leaders, and strong
advocates for our patient’s care and
safety, we should champion the
policy on professionalism, define
unacceptable behavior, and agree on
ways and means of rectifying
disruptive physician behavior. Thanks
to the national impetus and the
headlines recently made on this issue,
it is time that we address this matter
urgently.
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