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WORKING WITH PHYSICIANS

Physicians behaving badly: what to do when it affects patients

Poor physician behavior. It can run the gamut from rudeness to actions that invite malpractice claims. When does it cross the line from unpleasant to necessitating action from the practice? The answer is when it impacts the patient or has potential legal significance. And sometimes it does both.

Patient losses, court losses

The first concern is the patients. Whenever a physician’s behavior negatively affects patients, the office needs to address it promptly. That doesn’t mean a patient has to be on the receiving end of rudeness or even experience direct harm. It simply means the behavior is bad enough that patients notice it.

When a doctor shows outbursts of anger or berates a nurse or staff member within earshot of patients, consequences are apt to arise. At best, there’s going to be a loss of patients. Some of that loss will occur because patients simply go elsewhere. The rest of it will come in the form of declining referrals. Other doctors witness the behavior at the hospital or hear about it via the grapevine and drop their referrals because they don’t want to subject their patients to it.

Added to the patient loss is the risk that the doctor will expose the group to employment law claims.

That can happen, for example, if the behavior is discriminatory or falls into the area of sexual harassment.

A big danger is malpractice exposure. A good doctor-patient relationship, characterized by communication and confidence, tends to keep malpractice at bay

Good leadership plus counseling

The problem of disruptive behavior is not limited to medical practices. All professional organizations experience it, mainly because professional people are lots of times highly strung and highly motivated, which can lead to “a high level of tension in the practice.

The main line of defense, therefore, is a physician leader who can exercise authority, who can win the respect of the other doctors, and who can either moderate their behavior or nudge them into psychological counseling.

Counseling is the route medical organizations most often take when a member’s behavior is inappropriate. That’s because practices have a heavy investment in every physician and needs to keep their physicians on board if at all possible. Often the counseling takes the form of anger management. But it can also be organizational counseling geared simply to helping the doctor get a better organized lifestyle and thereby reduce the stress level. It’s not uncommon for a physician’s personal life to be so disorganized as to cause frustration and disruptive behavior.

What if it’s hopeless?

While most practices are able to solve their physician personality issues amicably, it can be necessary to dismiss a physician – not an easy job. Dismissing a doctor is far different from firing an employee, because doctors almost always work under employment contracts, and dismissals are governed by the terms of those contracts. Review the contract to see if the dismissal terms need to be changed. Offices tend to put agreements into place and then not look at them for years until they’re needed. And by then, there are gaps and provisions that don’t suit the current situation.

Some contracts say the group can terminate a physician for any cause whatsoever with a certain amount of notice. Others set out carefully defined instances of termination. Stay away from the open-ended contract, because it can lead to claims that the termination was personal retribution or age or racial discrimination. By contrast, when there is a carefully defined list of instances and one of them is violated, there’s little likelihood that a dismissed physician will bring litigation.

Make one of the trigger elements unacceptable behavior. The clause should say that disruptive, abusive, or unprofessional behavior will not be tolerated and that a doctor can be terminated for repeated instances of it.

With that spelled out, the office can handle a physician behavior problem the same way it would handle any staff behavior problem. All it has to do is build the case, or record what happens, warn, counsel, and document everything that’s done.

That way, a rare outburst on a bad day gets tolerated as an isolated event. But when the outbursts are habitual, the practice can show a pattern of repetition and solid ground for dismissal.

Behavior outside the office too

The behavior provisions of the contract need to cover behavior outside the practice as well as in it. It’s not uncommon to see that omitted. Employers are alert to issues that involve their own employees, yet rarely are they prepared to handle problems that involve somebody else’s employees. One such situation had a physician who was middle-aged and married starting carrying on an affair with a 23-year-old technician at the hospital. It was a small town, and the affair became an embarrassment to the practice. The other doctors met with the physician and told him to quit the relationship, but the response was “I’m in love,” and the situation went from bad to horrible with a nasty divorce following.

The doctors were wringing their hands. But because there was nothing in the employment contract to address behavior outside the practice, they had no basis to act. In the end, the love-smitten doctor left. But a provision in the contract could have given the practice a means of solving the issue much sooner.

The impaired physician – easier

Another type of behavior issue is impairment, whether by drugs or alcohol. Surprisingly, that’s easier to handle than the tense, stressed, brusque, and disruptive behavior. The place to turn is to the state licensing board’s impaired physician program. That type of program usually works quite well for several reasons. One is that doctors are willing to cooperate, because their entire professional life is at stake. They could lose their licenses. Another is that most practices don’t hesitate to refer doctors there because of the malpractice exposure impairment creates and also because the liability is worse when there is impairment. Impairment is quickly recognized in the medical office because the other doctors and staff are educated watchers and are aware when Dr. A is drinking or gobbling tranquilizers like candy.


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