The Disruptive Professional

This article examines certain critical aspects relating to the clinical competency of professionalism. A discussion is presented which is centered on an analysis of two fictional scenarios explored from the standpoint of a current and a former program director, an associate dean, a department chair, and a lawyer. These cases are followed by a series of questions and a legal discussion which can then be used for either individual study or group discussion.

Professionalism is limited not only to the interaction of physicians and patients, but also involves the interactions between other physicians and the health care team. As professionals, we are character “mentors” to our residents and peers. We learn from those around us and we pass this learning (“good” or “bad”) onto others.

Furthermore, medicine can only succeed as a respected position in society by maintaining and bolstering public confidence and respect for our profession. With that said, part of our “professional duty” is to deal with the “unprofessional” behavior, that behavior that can erode the work environment and taint society’s view of medicine.

This article is meant to stimulate action in dealing with the problem physician, “a disruptive professional.” Two fictional scenarios are presented to focus on the clinical competency of professionalism, specifically sexual harassment and the underperforming resident physician (the following case scenarios are based in part on a panel discussion held at the Annual Meeting of the Association of University Radiologists on April 28, 2007 in Denver, Colorado). These discussions propose several options on how to approach and deal with the particular problems raised by each scenario.

These case studies, their associated questions, and legal discussion are suitable for both an individual or group study.

Scenario 1. The friend

A married male program director is attracted to a new, first-year single female resident. Over the next several months, a relationship develops which is observed by both fellow residents and faculty. The program director leaves his wife and children, and the other residents start to express a concern that this first-year resident is receiving “preferential treatment.”

Questions for Small Group Discussion

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Comment

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Discussion

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Legal Discussion

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Quid pro quo

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Hostile environment

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Recommendations

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Scenario 2. The problem

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Questions for Small Group Discussion

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Comment

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Discussion

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Legal Discussion

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Conclusion

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References

1. Title IX, Education Amendments of 1972, 20, USC §§1681–1688.
2. Harolds J.A., Wood B.P.: Conflict management and resolution. J Am Coll Radiol 2006; 3: pp. 200-206.
3. Harolds J.A.: Program directors as conflict managers. Acad Radiol 2003; 10: pp. S67-S74.
4. Harolds J.A.: Selected important characteristics for enlightened leaders. J Am Coll Radiol 2004; 1: pp. 338-342.
5. Program directors guide to the common program requirements. Accreditation Council for Graduate Medical Education. Available at: http://www.acgme.org/acWebsite/navPages/nav_commonpr.asp . Accessed November 17, 2007. Available at: http://www.acgme.org/acWebsite/navPages/nav_commonpr.asp . Accessed November 17, 2007.
6. Civil Rights Act of 1964, Title VII, §703, 42 USC 2000e-2(a).
7. Accreditation Council for Graduate Medical Education. Institutional Review Committee. Institutional requirements. Available at: http://www.for successful completion of the programacgme.org/acWebsite/irc/irc_IRCpr703.asp . Accessed November 17, 2007. Institutional requirements. Available at: http://www.acgme.org/acWebsite/irc/irc_IRCpr703.asp . Accessed November 17, 2007.
8. Equal Employment Opportunity Commission. Guidelines on discrimination because of sex. 29 CFR 1604.11(a) (2003).
9. American Medical Association: Sexual harassment and exploitation between medical supervisors and trainees.2005.AMAChicago, IL
10. Rucupero P.R., Heru A.L., Price M., et. al.: Sexual harassment in medical education: liability and protection. J Med Ed 2004; 79: pp. 817-824.
11. Berlin L.: Sexual harassment. AJR Am J Roentgenol 2006; 187: pp. 288-293.
12. Lipsett v University of Puerto Rico, 864 F.2d 881 (1st Cir 1988).
13. Harolds J.A.: The radiology resident in perceived academic difficulty. Acad Radiol 1995; 2: pp. 1029-1031.

The Disruptive Professional

Scenario 1. The friend

Questions for Small Group Discussion

Comment

Discussion

Legal Discussion

Quid pro quo

Hostile environment

Recommendations

Scenario 2. The problem

Questions for Small Group Discussion

Comment

Discussion

Legal Discussion

Conclusion

References

Further Reading

Abstracts of Funded National Institutes of Health Grants

Breast MRI for Cancer Detection and Characterization

Communication in the Diagnostic Mammography Suite Implications for Practice and Training