Doctor, Are You a “Disruptive Physician?”

by Brian Carty, MD, MSPH
11-06-2008

Dr. X sat at a computer terminal at the nurses desk, angrily punching the keys of the keyboard, looking for his patient’s lab results.  His face flushed a deep crimson.  He shouted “Where are the !?&#%!! lab results!”   

Out of Control

Everyone at the nursing station knew the drill by now.  Dr. X picked up the keyboard, turned it on its side and pounded it on the desk.  The Q-W-E-R-T-Y keys went to the left and the Z-X-C-V-B keys to the right.  Then he raised the keyboard above his head and smashed it against the floor.  Keys and plastic fragments flew in all directions.

As Dr. X stomped off down the hall, the ward secretary pulled out a backup keyboard and began to clean up the mess.  She had a supply of spare keyboards and phones in a closet, ready for the next outburst.

Coworkers Traumatized

The nurse across the desk from the computer terminal covered her face with her hands and cried quietly.  The charge nurse stood in the break room.  She was on the phone with the hospital administrator.  She rolled her eyes as she listened to him say “But he’s our top admitter.”  There was a long pause, and then the administrator said “Look, I’ll call the nursing supervisor.”

Some Behavior is Unacceptable

Behavior such as throwing charts and instruments, shouting, profanity, and the like, is obviously disruptive, unprofessional, and unacceptable.

“Disruptive” Can Be a Catchall Term

However, “disruptive physician” guidelines can be vague and subjective and may be used to harass physicians who challenge the hospital administration on the quality of care provided by the hospital staff.

“Disruptive physician” guidelines allow hospital administrations to dismiss doctors from hospital medical staffs for actions such as refusing to join a hospital-sponsored HMO, offering a service that competes with the hospital, expressing political views that are disagreeable to the hospital administration, and voicing concerns about quality of care.  

Shabby Treatment of One Physician

The case of Dr. W, a surgeon at a Charleston, SC hospital, illustrates these concerns.  Dr. W openly complained about the quality of care his patients received at the hospital.  The hospital subsequently accused him of being a “disruptive physician.”

Dr. W Had Legitimate Complaints 

Here are some problems Dr. W complained about.  Dr. W ordered antibiotics for a woman with abdominal pain caused by diverticulitis, a serious infection of the colon.  The antibiotics were not given for ten hours.  The woman suffered a perforated colon and spent a month in intensive care.  In another case, vital signs (temperature, pulse, blood pressure, and respiratory rate) of one of Dr. W’s patients were not checked for 48 hours. 

Is Making a Written Complaint “Disruptive Behavior?”

Dr. W made a number of written complaints to the hospital administration regarding such deficiencies in medical care. The hospital then claimed that Dr. W was guilty of disruptive behavior.  The episodes of disruptive behavior were these written complaints.

A Good Doctor Is Ruined For Trying to Do a Good Job

The hospital summarily dismissed Dr. W from the hospital staff.  The hospital then reported him to the national data base for doctors who have malpractice suits or disciplinary actions - the National Practitioner Data Bank (NPDB). His practice is ruined, and the NPDB report has made him virtually unemployable.

“Disruptive” Hospital Administrators

It’s interesting that there are no “disruptive hospital administrator” or “disruptive CEO” guidelines.  A CEO may fire a highly competent doctor who is trying to insure quality medical care.  Of course, in doing this, the CEO is being highly disruptive.

 

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