In response to standards put forth by The Joint Commission, the American Medical Association, through its Council on Ethical and Judicial Affairs, continues to voice its ongoing support for use of the designation “Disruptive Physician” as a mechanism for potential discipline of physicians. In doing so, the AMA has created two distinct forms of “physician behaviors” upon which such actions can be based.
1. Inappropriate Conduct
Inappropriate behavior is conduct that is unwarranted and is reasonably interpreted to be demeaning or offensive. This behavior can have a detrimental effect on relationships between healthcare practitioners. Inappropriate behavior includes such things as belittling or berating statements, use of profanity or disrespectful language, inappropriate comments written in the medical record, deliberate failure of cooperation without good cause, and refusal to return phone calls, pages, or other messages concerning patient care or safety. Persistent, repeated inappropriate behavior can become a form of harassment and thereby rise to the level of disruptive behavior.
2. Disruptive Behavior
Disruptive behavior is defined as any abusive conduct, including sexual or other forms of harassment, or other forms of verbal or nonverbal conduct that harms or intimidates others to the extent that quality of care or patient safety could be compromised. Disruptive physician behavior includes, but is not limited to:
• Physically threatening language directed at anyone in the hospital including physicians, nurses, other medical staff members, or any hospital employee, administrator or member of the Board of Directors;
• Physical contact with another individual that is threatening or intimidating; • Throwing instruments, charts or other things;
• Threats of violence or retribution;
• Sexual harassment; and,
• Other forms of harassment including, but not limited to, persistent inappropriate behavior and repeated threats of litigation.1
As this mechanism grows in use, and misuse, physicians, historically revered, honored and beloved by society are no longer being afforded deference by their patients, peers or other clinicians who work with them. Twenty years ago, a physician, known to be abrasive, argumentative, flirtatious with staff or patients, or even demanding in the operating room, would rarely become the subject of scrutiny. Today however, such a physician, whether new to practice or amply experienced, whether a specialist or a general practitioner, and whether internationally renowned or local, can easily be labeled a “disruptive physician”. In the new investigatory, regulatory and competitive climate of healthcare environment, it is critical for physicians to avoid even the inference of being “disruptive”. However, in order to do so, every physician must acquire an understanding of the new healthcare risk landscape and how to maintain a risk prevention “state of mind” with both patients and staff.
Who, or what, defines a physician as “disruptive”?
“Disruptive”, as a newly developing legal term of art, is not only being defined by the AMA but also governs the conduct of physicians through a variety of documents that set expectations for physician conduct including, but not limited to, medical staff bylaws, employee manuals/handbooks, state and/or federal regulations, employment contracts, etc. These documents also typically contain related clauses that set forth the ability to tie disruptive conduct to physician discipline or termination. Disruptive conduct includes hostility, tardiness, belligerence, incompatibility with patients or staff, religious insensitivity, cultural insensitivity, racial insensitivity, uncooperative beha