The Disruptive Physician

Rationale and Objectives

This article addresses the medical and legal implications of disruptive physician behavior. In addition, this article will address the appropriate use of due process in peer review of disruptive physician behavior.

Conclusions

While most hospitals and even national organizations, like the American Medical Association, have definitions for what constitutes disruptive physician behavior, these definitions have been further examined and clarified in court rulings. These court rulings not only further clarify what constitutes disruptive behavior but also establish a threshold for revocation/nonrenewal of a physician’s hospital privileges.

All physicians experience pressures and frustrations in their careers ranging from, literally, making life-and-death decisions in medical management to declining income and increasing regulatory burdens . In this high-pressure setting, events and circumstances may be enough to “test a saint” . Anger, frustration, and even the occasional swear can be normal human responses when confronted with the broad range of stressors and responsibilities in a physician’s career. However, there is a point where a physician’s behavior can cross the line from expected emotional responses to disruptive behavior.

Professionalism has long been seen as an “Aunt Minnie” (eg, you know it when you see it). The same can be said about unprofessional behavior. Unfortunately, such subjective descriptions are of limited value when writing hospital policy, evaluating a physician’s behavior, or trying a case in a court of law. Subsequently, this article will explore the legal precedents set by court rulings in which physician behavior was deemed a legitimate reason to revoke or refuse renewal of physician staff privileges.

While harassment, of any form, is certainly disruptive behavior, in terms of legal precedent, this is typically addressed under Title IV of the 1964 Civil Rights Act and Title IX of the Education Amendments of 1972 . Instead, the focus of this article will be the other unprofessional behaviors covered under the increasing well-defined legal precedents defining “disruptive behavior.”

Definition and prevalence disruptive behavior

As medical professionals, we have an instinctive understanding of what constitutes disruptive physician behavior. Many of us may be able to recall an example of a disruptive physician from our training and subsequent careers:

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Lessons from case law

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Potential causes of disruptive physician behavior

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Impact of disruptive behavior

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Addressing disruptive behavior

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Table 1

Essential Steps that an Organization Should Take to Deal with Disruptive Behaviors as Outlined by the American Medical Association.

Accessed at https://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9045.page . Last accessed July 12, 2013.

Table 2

Suggested Actions for Dealing with Disruptive Behavior from The Joint Commission.

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http://www.jointcommission.org/assets/1/18/SEA_40.PDF . Last accessed July 12, 2013.

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Table 3

Guiding Principles for Hospital’s Peer Review Process of an Alleged Disruptive Physician.

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Conclusion

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References

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The Disruptive Physician

Rationale and Objectives

Conclusions

Definition and prevalence disruptive behavior

Lessons from case law

Potential causes of disruptive physician behavior

Impact of disruptive behavior

Addressing disruptive behavior

Conclusion

References

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