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"Hi, my name is Doug"
"Hi, Doug."
"And I am a disruptive physician."
It isn't easy admitting to this "label" anymore. Don't get me wrong, I don't buy into the definition given by the Joint Commission or hospitals or whomever has jumped on the bandwagon. That's the problem. The label "disruptive physician" is just that....a label. It can be defined in so many ways.
The New York Times put out a piece entitled Arrogant, Abusive and Disruptive — and a Doctor which tried to blame much of the problems in the hospital on these few doctors. The article even tried to make the claim that "disruptive physicians" are the cause for most medical mistakes. The problem is that the study they used was a survey and therefore inherently unscientific. The piece obviously was coming from a nursing point of view and much of what they have to say is valid. The example of the one nurse ducking scalpels being thrown at her was a little over the top, though.
Don't get me wrong, there are a lot of physicians that are arrogant and rude. As a lowly family doc, I get some of their wrath as well. Here was an example I spoke about at a lecture. As rude and belittling as this nephrologist was to me, I am not sure I would label her "disruptive". I have a few other labels I would use under my breath but it wouldn't be appropriate to share them here.
Some people are jerks; plain and simple. I remember nurses on the labor and delivery floor ganging up on a physician they didn't like. They tortured him and not because he was arrogant or rude to them. I remember being a medical resident and telling the nurse of the ICU patient I was caring for that I thought we needed to do a lumbar puncture. She replied, "Good for you" and walked away. Everyone has the ability to be jerks.
The problem with the term "disruptive behavior" is that it can be used as a weapon. Now JCAHO or Joint Commission or whatever they are called (asswipes?) are on the case. They recently issued a sentinel event alert on disruptive behavior that said "intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities. ... Such behaviors include reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions." Could they have cast a wider net? You have got to be kidding me. Even the AMA was questioning this.
More and more doctors are being labeled "disruptive physicians" by hospitals in order to force them to shut up. This is a problem. The definition by the Joint Commission only adds to the fire. It enables the hospitals to claim they have no choice but to label these doctors in order to achieve their accreditation. Meanwhile, they are just trying to get doctors to become lemmings.
Yes, there are arrogant and rude doctors and nurses and administrators. Yes, physically threatening someone or violent outbursts should not be tolerated. But speaking up, changing your voice intonation to make a point and fighting for what is right is not a crime. It may be disruptive but that kind of disruption is what's needed.
"My name is Doug. I am a disruptive physician. And I am proud of it."
6 comments:
Doug,
I think it's hilarious that JCAHO finds physicians potentially disruptive. Is that 'the Cuban calling the North Korean a commie,' or what?
I wrote a post on the topic if you want to have a gander:
http://edwinleap.com/blog/?p=247
Keep up the good work!
Edwin Leap
Wish u Merry Christmas. I liked your Christmas post... I also want to present my Christmas 2009 just like yours. Would you be interested to exchange link with my PR4 Blog.
Howdy Doug,
Interesting post. I'm going through a metamorphasis from clinician to administrator, so my take may be a little different. It's never been my intention to silence anyone - I'd rather give them the communication skills to avoid the disruptive behaviour.
Another thought - the diagnosis of disruptive physician requires a thorough history and examination of the ground. A simple complaint won't cut it.
My definition is a little different though. Disruptive behaviour is behaviour that either has a real or potential negative affect on patient safety.
Back to you.
Though your definition is better is still can be used and exaggerated by the administrators to castrate them.
Howdy Doug,
I think that's too easy; there is a difference between "can" and "has". Furthermore, in my hospital at least, there is process to be followed.
Can you show that this definition, or any for that matter "has" been used to silence a physician,as opposed to being used to object to "how" the physician communicated?
In my view a physician who tells a colleague that a decision was wrong for reasons A, B and C is communicating well and is non disruptive. One who says that the colleague was effin stupid for doing something is disruptive.
As I said - no one wants to silence doctors. But it would be nice to have a collegial work environment, not only among physicians but among all who work for the benefit of our patients.
Back to you.
Doug,
All members of the healthcare team, including physicians, should be able to work without exposure to "disruptive behavior." It is counterproductive to providing good patient care. Certainly there is the potential for abuse, but only if we, as physicians, allow it. Medical staff leaders need to strictly define what is inappropriate behavior and which medical body (Peer Review Committee, eg) enforces it. Further, interventions such as personal meetings, educational programs,etc., can correct such behavior before any more drastic measures would be needed.
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