1. Winning Together with the Destructive Physician
Will Latham
Latham Consulting Group

2. “From the violent nature and multiple stab wounds,
I’d say the victim was probably a consultant.”

3. Dial 911

4. Consult an Attorney

5. What is a Disruptive Physician?
… Disruptive physician behavior consists of a practice pattern of personality traits that interferes with the physician’s effective clinical performance.
Norman T. Reynolds, MD
Journal of Medical Regulation, Vol 98, No 1

6. What is a Disruptive Physician?
…one whose actions are contrary to the best interests of the practice, or jeopardizes the morale or even tenure of the group and its radiologists members.
Larry Muroff, MD

7. What Does It Look Like?
Degrading comments or insults
Discriminatory behavior
Inappropriate joking
Incompetence
Physical assault
Profanity
Refusal to cooperate with others
Refusal to follow established protocols
Retaliation
Spreading malicious rumors
Substance abuse
Throwing objects
Yelling

8. Why Do We Have Disruptive Behavior?

9. Workload
Learned behavior (medical school)
Other members of the healthcare team
Non-work related causes
Policy or procedure related
Other root causes

10. Why Do We Have Disruptive Behavior?
Because We Tolerate It

12. Why Do We Tolerate It?
Because We Are Conflict Avoiders

13. Conflict Style Competing Collaborating Avoiding Accommodating
Compromising
Assertive
Passive
Uncooperative
Cooperative
Conflict Style

14. Conflict Continuum Mean-Spirited Personal Attacks Artificial Harmony
Constructive
Destructive
Ideal
Conflict
Point

15. We Focus Here

16. We Should Focus Here

17. Disruptive Behavior Occurs at least Once a Month
> 70%
Disruptive Behavior Occurs at least Once a Month

18. Disruptive Behavior Occurs at least Once a Week
> 37%
Disruptive Behavior Occurs at least Once a Week

19. Disruptive Behavior Occurs on a Daily Basis
> 10%
Disruptive Behavior Occurs on a Daily Basis

21. If men were angels,
no governance
would be necessary.
- James Madison 

22. What Do We Do?
Prepare for Problems

23. Employment Contract Protective Clauses
Termination without cause (2/3rd vote).
Non-compete.
Automatic resignation from all group’s hospitals at the end of employment.
All medical employment work with group.
Protection against sale/repossession of stock to/by an outside entity.

24. What Do We Do?
Careful Hiring

25. Careful Hiring
Consider factors beyond clinical competence. Can they play well in the “sandbox?”
Explain group “norms” and specifically ask if they are willing to adhere to them.
Rehabilitation is unlikely.

26. What Do We Do?
Mentoring

27. Strengthen Our Ability to Deal With Disruptive Behavior
What Do We Do?
Strengthen Our Ability to Deal With Disruptive Behavior

28. Disruptive Physiciansx x x x x x x x x

29. Disruptive Physiciansx x x x x x x x x

30. Disruptive Physicians
Normative Behaviors x x x x x x x x x

32. If I didn’t vote for it,

33. If I didn’t vote for it, or I don’t agree with it,

34. I don’t have to do it. If I didn’t vote for it,
or I don’t agree with it,
I don’t have to do it.

35. The Foundation: Decision-Making
How will the group make decisions?

36. The Foundation: Decision-Making
How will the group make decisions?
Talk and vote?

37. The Foundation: Decision-Making
How will the group make decisions?
Talk and vote?
What is expected of each physician once a decision is made?

38. The Foundation: Decision-Making
How will the group make decisions?
Talk and vote?
What is expected of each physician once a decision is made?
What you want to hear is “support it,” “do it,” “not sabotage it,” etc.

39. The Foundation: Decision-Making
How will the group make decisions?
Talk and vote?
What is expected of each physician once a decision is made?
What you want to hear is “support it,” “do it,” “not sabotage it,” etc.
What are a physician’s options if he or she doesn’t like the decision?

40. The Foundation: Decision-Making
How will the group make decisions?
Talk and vote?
What is expected of each physician once a decision is made?
What you want to hear is “support it,” “do it,” “not sabotage it,” etc.
What are a physician’s options if he or she doesn’t like the decision?
Do it anyway – that’s group practice
Try to get it change, in the appropriate forum.
Self-select yourself out of the group.

42. Code of Conduct Questions: Set expectations for:
What behaviors do we expect of each other? What is acceptable to us? What is inappropriate?
What are some of the unwritten rules that guide our behavior?
What are the rights and responsibilities of each physician?
Set expectations for:
Interactions between physicians.
Interactions with employees.
Interactions with those outside the group.
Practice management responsibilities.
Support of group decisions, established goals and policies.

43. Establish Group Policies
Impairment (substance abuse, eroded skills, psychological
Sexual harassment/creation of a hostile work environment.
Disability.
Nepotism.
Leave.
Notes:
Work with your attorney – these policies can be governed by state and federal requirements.
Set them before you need them.

44. Establish a System to Deal with Disruptive Physicians
What Do We Do?
Establish a System to Deal with Disruptive Physicians

45. Consequences There must be a consequence for disruptive behavior.
These consequences must apply to all.

46. Disciplinary Enforcement Process Options
Rulebook.
General System.
Rules Based System.

47. Rulebook If you do “X”, then “Y” happens.
BTW – it’s up to the manager to implement “Y”
Problems:
“I didn’t get into medicine to have to follow a rule book”
“We can’t think of everything.”

48. General System President of group tries to fix.
“Physician Affairs Committee” tries to fix.
Board fixes.
Problems:
Typically no authority for consequence until the Board.
Conflict avoidance at its best!

49. Rules Based System
Similar to General System, but guidelines for dealing with infractions.

50. Type of Offense
Category 2
First Offense
$1,000 and outside counseling paid for by physician.
Second Offense
$3,000 and outside counseling paid for by physician.
Third Offense
$5,000 and outside counseling paid for by physician.
Example Category 2 Offense:
Harassment.
Reporting to work under the influence.
Gambling or fighting.

51. Meaningful Consequences
Re-education or training.
Documented verbal warnings.
Written warnings.
Withhold bonus money.
Penalty per violation.
Self-payment for additional education.
Self payment for additional staff.
Losing priority status for scheduling vacation.
Assigned extra call.
Loss of voting privileges (A to B Shareholder)
Probation.
Temporary suspension.
Demotion.
Termination.
Restitution for damages.
Referral for criminal prosecution.

52. Confronting the Disruptive Physician (Gulp)
What Do We Do?
Confronting the Disruptive Physician (Gulp)

53. Confronting Problem Behavior
Focus on behavior, not personality.
Describe the specific situation that illustrates the behavior you are concerned about.
Explain why it concerns you and express your desire for change.
Seek out and listen to the individual’s reasons for this behavior.
Inform the individual how improved behavior will improve his/her relationship with the group.
Ask for the individual’s ideas and commitment to solving the problem.
Offer your encouragement and support.
Agree on an action plan and set a date to discuss it.

54. Pain is inevitable.
Suffering is optional.