Monday, October 25, 2004

"Doctor, we have a problem..."

Doctor, are you known as the "Mount St. Helens" of the medical landscape? Does your staff don protective gear before telling you bad news? In this month's Psychiatric Annals, Dr. Larry Harmon, PhD, and Dr. Raymond Pomm, MD, report on "Evaluation, Treatment, and Monitoring of Disruptive Physician Behavior." It's not available online. Here are some excerpts:

"Disruptive behavior includes such conduct as using foul and abusive language, threatening associates, criticizing staff in public, and relying on intimidation to manipulate others. Recent case law defines disruptive physician behavior as conduct that 'disrupts the operation of the hospital, affects the ability of others to get their jobs done, creates a 'hostile work environment' for hospital employees...or begins to interfere with the physician's own ability to practice competently."

They report that one survey of perioperative nurses found "91% experienced verbal abuse by physicians," while another survey reported "92.5% of nurses had witnessed disruptive behavior, the most frequent being yelling or raising the voice, disrespect, condescension, and berating of colleagues." They note that mood disorders and personality disorders are often present, especially those with narcissistic and obsessive-compulsive traits.

(Yes, of course, say the nurses; we know all this. But what can be done about it? As the president's advisor said, "I prefer to let others run into the propeller...")

These authors are trying to dismantle the propeller...or at least slow it down a bit. They report on a survey program that aims to identify disruptive physicians and provide feedback about their workplace conduct. The program, called PULSE (for "Physician's Universal Leadership Skills Survey Enhancement"), asks healthcare and medical staff to complete "interpersonal skills" surveys on individual docs. They're presented as an "early warning" system to "modify conduct before it becomes subject to disciplinary action." "Physicians whose conduct ratings are in critically unfavorable ranges may be encouraged to obtain assistance from various sources such as...state physician health program, local mental health professionals...a stress or anger management program, or a 'workplace coach.'"

My guess is that most docs who receive such "encouragement" will realize that disciplinary action may ensue if they don't comply. Florida has a system that balances the need to address impaired MD's and prevent them from harming patients, while protecting the confidentiality of the docs. It's a system that more states should adopt.

Here are some resources provided by the authors.
For evaluation:
Physicians Development and PULSE Survey Programs
Professional Renewal Center
Vanderbilt University Center for Professional Health
For education:
University of Alabama Health for the Healer: 205-975-7931
T.E.A.M. Program
Distressed Physician Program, Vanderbilt
For inpatient/residential treatment:
Talbott Recovery Campus
Professional Enhancement Program, Pine Grove Treatment Center
Center for Professional Excellence
Professional Renewal Center
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