2017 HSC Section 2 - Practice Management
Reprinted by permission of Acad Radiol. 2013; 20(9):1069-1073.
The Disruptive Physician:
A Legal Perspective
Michael J. Grogan, MD, JD, Paul Knechtges, MD
Rationale and Objectives: This article addresses the medical and legal implications of disruptive physician behavior. In addition, this ar- ticle 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. Key Words: Disruptive physician behavior; professionalism; medical-legal issues. ª AUR, 2013 A ll physicians experience pressures and frustrations in their careers ranging from, literally, making life- and-death decisions in medical management to 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: ‘‘They’re out there . browbeating nurses and pharmacists, dressing down hapless staff, belittling patients to their faces, swearing at the tops of their voices, muttering ominous threats, dripping sarcasm and snide innuendo, slouching in late day after day, raging, sulking, hurling surgical instruments, blowing off appointments, sabotaging meetings, sneering at administrators, insulting their colleagues, refusing to answer pages, addling their judgment with drink or drugs, breaching sexual boundaries . ’’ (3) . Disruptive behavior is a common problem, with 18% of physician executives stating they encounter disruptive behavior on a monthly basis in their organization and another 14% dealing with it on a weekly basis (3) . The Alabama, Kentucky, and Wisconsin state medical societies have published data showing disruptive behavior encompasses 30% of their complaints (5) . The estimated prevalence of disruptive behavior among all US physicians is 5% (3) . Usually the disruptive behavior results from conflict between a physician and a nurse. The American Medical Association (AMA) states, ‘‘Per- sonal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care constitutes disruptive behavior. (This includes but is not limited to conduct that interferes with one’s ability to work with other members of the health care team.) However, criticism that is offered in good faith with the aim of improving patient care should not be construed as disruptive behavior’’ (6) . Disruptive behavior includes verbal assaults that are personal, irrelevant, rude, insulting, or otherwise
declining income and increasing regulatory burdens (1–3) . In this high-pressure setting, events and circumstances may be enough to ‘‘test a saint’’ (3) . 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 IVof the 1964 Civil Rights Act and Title IX of the Education Amendments of 1972 (4) . Instead, the focus of this article will be the other unprofessional behaviors covered under the increasing well-defined legal precedents defining ‘‘disruptive behavior.’’
Acad Radiol 2013; 20:1069–1073 From the Saint Paul Radiology, 166 4th Street East, St. Paul, MN 55101 (M.J.G., P.K.). Received December 8, 2012; accepted April 25, 2013. Address correspondence to: M.G. e-mail: mgrogan@stpaulrad.com ª AUR, 2013 http://dx.doi.org/10.1016/j.acra.2013.04.015
53
Made with FlippingBook flipbook maker