Difficult Doctors A Process for Responding Constructively When Doctors Behave Badly1,2 A Presentation for Nursing Stu

1. Difficult DoctorsA Process for Responding Constructively When Doctors Behave Badly1,2A Presentation for Nursing Students Kendall L. Stewart, MD, MBA, DFAPA May 19, 2009

2. Why is this important? Doctors can be difficult. When they are, they create real problems in the workplace. Because of their status or power, bigwigs regularly indulge in destructive behavior with no significant adverse consequence. Temper tantrums are overlooked. Intimidation is accepted, even reinforced. Verbal abuse is tolerated and tyrants are lionized. Even physical abuse and destruction of property are more common than we would like to admit. But tolerating and thereby encouraging such behavior exacts an awful price. Disruptive behavior wounds others and leaves lasting organizational scars. After mastering the information in this presentation, you will be able to Define the scope of the “difficult doctor” problem, Describe exactly how difficult doctors behave, Explain how difficult doctors “make” you feel, Describe how your feelings “make” you behave, Detail some effective organizational strategies for dealing with difficult physician behavior, Identify a process for dealing more effectively with difficult physician behavior, Explain why this process will help, and Explain how to it. All kinds of bigwigs regularly misbehave, but we bystanders are not as powerless as we sometimes feel.1,2

3. What is the scope of this challenge? Preparing to Deal with Difficult Doctors Preparing yourself1,2 Preparing physician leaders Preparing executives Preparing trustees Preparing managers Preparing employees Annoying Doctors Negative doctors Selfish doctors Unreasonable doctors Whining doctors Disorganized doctors Immature doctors Disruptive Doctors Angry doctors Abusive doctors Dishonest doctors Arrogant doctors Felonious doctors Dangerous Doctors Marginal doctors Incompetent doctors Impaired doctors Distracted doctors Careless doctors Overwhelmed doctors

4. How exactly to difficult doctors behave? They are disrespectful. They berate colleagues publicly. They use abusive language. They indulge in condescending behaviors. They throw temper tantrums. They intimidate and threaten. They engage in sexual harassment. They lie, cheat and steal. They are insulting. They are upsetting to patients. They throw things. They slam doors and hit walls. They may even physically assault others.1,2

5. How do difficult physicians’ behaviors “make” us feel? Hopeless Resentful Angry Hurt Discouraged Frustrated Helpless Enraged Unappreciated1,2 Rejected

6. How do our feelings “make” us behave? Withdraw Nag Argue Give up Explain Talk behind others’ backs Ruminate Gossip Try harder to please Plot revenge1,2

7. What are some organizational strategies for dealing with difficult doctors? Acknowledge the problem. Make a commitment to manage the problem. Clarify your behavioral expectations. Require physicians to agree to behave. Field the best possible executive team. Recruit a strong physician executive.1,2 Initiate a culture change. Delegate with care. Investigate and document allegations promptly, dispassionately and thoroughly. Insist on fairness. Confront physicians effectively. Consider all options and choose the best one. Propose a reasonable solution and force dissenters to appear unreasonable. Inform medical staff leaders; do not consult or seek consent. Follow up promptly with staff members. Send resolution letters immediately. Dismiss nuisance complaints quickly. Give your stars the star treatment.

8. What is a typical “difficult doctor” scenario?

9. What mistakes have you seen people make in such circumstances? Getting into a yelling match on the spot Failing to attempt to contain the outburst Agreeing with the doctor that the outburst was justified Failing to document the outburst objectively Confronting without objective documentation Confronting inappropriately Confronting without prior senior management support. Failing to attach any unpleasant consequences Responding while still emotionally aroused Failing to accept the victims’ feelings Failing to point out that imperfections do not justify such outbursts Failing to confront disruptive behavioral patterns Being drawn into distracting arguments and away from the disruptive behavior1,2

10. What process, if followed, will most likely produce the best outcome?1,2 Label difficult physicians as “difficult.” Recognize that disruptive behavior is an organizational crisis that must be managed promptly. Recognize and monitor your own emotional arousal. Employ appropriate mental distractions. Minimize the emotional contagion. Begin the documentation immediately. Hear people out. Accept everyone’s feelings. Do not permit feelings to contaminate the documentation. Encourage a cooling-off period. Set realistic expectations for the staff. Clarify your expectation that a follow-up discussion with the physician will occur. Accept the physician’s frustration but not her behavior. Attempt to resolve incidents at the lowest possible organizational level. Suggest an early apology for inappropriate behavior and language. Follow the SOMC progressive corrective action model. Prepare to confront. Follow your script. Follow through on your promises to elevate the issue to the appropriate level. Reinforce more appropriate subsequent behavior.

11. What have we learned? More effective teamwork with physicians is essential to our organizational success. Tolerating inappropriate behavior from physicians (or anyone else) will undermine our efforts. Building effective relationships demands a considerable emotional investment. We should focus on our own—not others’—attitudes and behaviors since we have less control over theirs. Total success is not possible.1 Incremental success is easily achievable. This is a process, not an occasion. But executing these strategies will result in some wonderful occasions too.2