Of the issues and problems that can arise in a medical practice, disruptive behavior on the part of a physician is one of the most difficult to address. Such behavior may involve failure to attend meetings or being late for work and may even extend to something as serious as harassment of staff. The American Medical Association (AMA) has defined disruptive behavior as “personal conduct, whether verbal or physical, that negatively affects, or that potentially may negatively affect, patient care.”
What to do
This type of behavior, if it continues, can jeopardize your practice. It can not only hurt your practice’s reputation, but also lead to civil lawsuits and possible legal charges, depending on the nature and severity of the behavior. Clearly, you need to know how to deal with a disruptive physician. Here are some strategies that can help:
Confront the issue
Ignoring complaints is not a good approach in a medical practice or in any other workplace. Let staff and patients know that you take their complaints seriously by investigating and taking measures to resolve the behavior. Document the complaints or ask any person making a complaint to file a written report. Assure the person that you will keep the matter confidential and that there will be no negative consequences for blowing the whistle. Having a whistleblower policy as part of your personnel policies can also be helpful in this area. Additionally, ask the person to let you know immediately if he or she thinks the subject of the complaint is retaliating.
Then, decide on a course of action. This requires knowledge of the complaint and the parties involved. You may want to discuss the issue with the subject of the complaint in private. Alternatively, you might wish to obtain the support of a trusted and authoritative figure within the practice to serve as impartial witness to any discussion, so as to reduce the risk of misunderstanding. Either way, they need to be given the chance to present their side of the story. Document the results of the discussion. Irrespective of size, the practice should have an established procedure for dealing with a disruptive staffer.
Prepare your strategy for addressing the complaint with an outline of topics you plan to discuss with the subject. Stick to the script. Bring your practice’s code of conduct and any other written policies that apply. Explain the complaint in a factual matter, describing the sequence of events and the effect of the behavior on the person making the complaint. Outline the potential impact on staff, patients and the practice. Allow the physicians to defend themselves, but try to keep the subject focused on the specific complaint. In situations like this, the subject may become defensive and blame their behavior on various internal grievances, which should be dealt with at a separate time. It is easy for these types of discussions to go off the rails, so work on staying on track.
Ask the person who is the subject of the complaint for suggestions on how to address this issue and how to prevent future problems. Consider whether this behavior may be related to substance abuse or mental health issues. If the behavior is potentially illegal, you should consult with an attorney.
Get it in writing
Assuming you conclude the complaint is justified, inform the subject physician that a written performance improvement plan (PIP) will require changes in his or her behavior. The PIP must outline penalties for failure to comply, up to and including termination. The PIP must have measurable and objective goals. As with the original meeting, document this meeting thoroughly. The key elements of a PIP include:
- A statement of the action that caused the complaint;
- A plan of action with specific goals;
- A timeframe in which the subject must achieve all the goals; and
- A statement of the actions that will be taken if these goals aren’t met.
It is all too easy to let these sorts of issues fester. Matters of abuse or harassment can become messy. But, it is not enough to just deliver a warning—following through is essential.
Determine if inappropriate and unacceptable behavior has occurred
What happens if a physician is accused of sexual harassment, or other abusive treatment, of patients or staff? Even if your practice has a healthy and respectful culture, develop a prevention plan in case of abusive behavior, including regular training in sexual harassment, appropriate behavior and communication. Develop clear policies for all staff to follow and implement a pathway for staffers to make complaints without fear of retaliation. Consult an attorney immediately to determine how to protect the staff and the practice moving forward.
The best medicine
Of all professionals, physicians should be first to understand that prevention is the best medicine. Creating policies and stepping in early before the problematic behavior gets worse is the best way to maintain a healthy workplace.
Sidebar: 5 tips for dealing with disruptive staff
Here are some useful tips:
- Create an office code of conduct that clearly outlines expected behavior.
- Be measured in response to the complaint.
- Understand the root cause and provide multiple solutions, such as professional help or time off, to avoid making a problematic physician feel as if he or she is under attack.
- Realize that, while some behavior can be addressed by confronting the subject of a complaint, other behavior may require legal action.
- Pay attention to warning signs and even gut feelings during hiring. Make sure to speak to references and involve staff in your hiring process.