By Steven Reames, Executive Director, Ada County Medical Society
When I heard the term “disruptive physician” for the first time, I imagined it was something akin to a kid in a classroom who had lost their self-control, was throwing a temper tantrum, and who caused other students, teachers, or staff to feel unsafe. Those pictures certainly fit the worst-case scenarios of physicians whose emotional intelligence and self-regulation have taken a leave of absence: surgeons who throw scalpels at interns or nurses, doctors who blow up if their authority is questioned or threatened, a physician who dresses down a co-worker in front of others.
Those are clear violations of the AMA's Code of Ethics:
The importance of respect among all health professionals as a means of ensuring good patient care is foundational to ethics. Physicians have a responsibility to address situations in which individual physicians behave disruptively, that is, speak or act in ways that may negatively affect patient care, including conduct that interferes with the individual’s ability to work with other members of the health care team, or for others to work with the physician.
But let’s be honest: there are also times when doctors act out like any human might in the middle of a stressful situation. I heard of one who had “a little yelling incident” with clinic staff. The administrator referred him to the medical staff wellness lead for some follow-up because they were “disrupting the clinic” and simultaneously cc’d to HR. Upon some compassionate inquiry, it turned out that the clinic was short-staffed, short-supplied, and the physician had popped a cork because the printer had failed, again!
If you cannot do your job effectively and efficiently because you cannot even print a flippin’ prescription or guidance for patients for several weeks in a row, it is easy to imagine even a highly trained professional losing their cool.
And then there are the situations where physicians who offer sound criticism in good faith are labeled disruptive. I know a few too many doctors who have chosen to leave an employer and pursue practice elsewhere because they were branded too needy, a whiner, or “not a team player.” Perhaps they were, in fact, a little more cynical than skeptical and the contractual relationship was no longer a good fit. Certainly, the administration had grown tired of them pointing out systemic issues that created chaos in the provision of medical care.
Either way, the greatest irony about this is when an innovative and industry trend-setting CEO does the same thing, they get to wear the “disruptive” badge with pride. It is completely acceptable for them to upset the apple cart: shuffle the organizational chart, transition to an accountable care organization, or dispose of parts of the company that are no longer profitable. But when the ground troops speak up about how those same changes create intolerable working conditions, they never quite get the same respect.
Hmmm.
One of the things that still surprises me about the AMA’s code of ethics is their outdated advice here: “As members of the medical staff, physicians should develop and adopt policies or bylaw provisions that establish a body authorized to receive, review, and act on reports of disruptive behavior, such as a medical staff wellness committee.” No wonder wellness committees have been viewed by physicians with such skepticism for so many years if they have only been used as iron fists in a velvet glove.
Last year, I was introduced to another term that might allow us to see “disruptive” people with a view towards evolutionary growth. Lori Tucker recently finished her doctorate on formerly “abrasive leaders,” a College of Idaho Visiting Assistant Professor, and local executive coach. She was the first to explore the experience and meaning-making of people who previously displayed detrimental interpersonal behavior at work. What she found is that abrasive and disruptive leaders do need interventions. However, the way they are handled can make or break the opportunity for them to grow in their own emotional intelligence and enhance their leadership abilities.
Since healthcare institutions often treat their workplaces as industrial production lines, it makes sense to them when they feel anything disrupting productivity should be addressed. But hopefully, the proper care and handling of physicians post-COVID is starting to pop up on C-suite priorities too. It is well past time to rethink our notions of what is and is not disruptive and how to deal with it redemptively.
The practice of medicine introduces external pressures (like unrealistic expectations) and exposes internal weaknesses (like perfectionism) that some doctors are not well prepared to meet. The hardest job of leadership is not to steer an organization of optimally performing workers to success. It is to help individual human beings over the hump of their struggles so they can contribute at a higher level.
