Disruptive Physician - Are you one?

ever heard of a disruptive physician? i've gotten quite an education on the topic in the last month. there are two surgeons, both in the ENT dept at our publc hospital, who are being forced out of their jobs. Every conflict has two sides so this may sound a bit biased, but after my experience of being forced to resign from UNMH, and having met personally with these two physicians, I am convinced that they are honest, skilled, caring doctors being targeted and pushed out for their advocacy for patients, their concern about certain unethical behaviors within their department and for standing up to the intimidation being thrown at them by their administrators. Our hospital administrators love to play tough with people who express moral or ethical concerns. there is alot to the story of these two physicians that will have to wait for public disclosure but i am proud to say that my community has taken the step of publicly asking the hospital to ensure that these two gentleman have due process and a fair trial. we'll see where it goes from here.

so what is a disruptive phsycian? if you do a google search, you will find plenty of info. in summary, a disruptive physician is a doctor who jeapardizes or compromises patient care by their attitude, behavior, actions, prejudices, etc. a perfect example is a doctor who has caused so much fear in the nursing staff that they are afraid to call that doctor to report a health concern with a patient and the patient has a bad outcome. one could blame the nurse or one could see the deeper toxic dynamic the doctor set up over time by punishing the nurse inappropriately.

it's important for any clinic or institution to be able to identify a disruptive doctor and take corrective or terminative action. when patient care is at the center of the mission, this is a critical necessity. i know plenty of disruptive doctors (we all do). they are all over the place in medical education. they are typically mean, obstructionist, angry, incompetant, and insecure in their abilities. and i wish there were ways to get rid of them because they made my life miserable and they were fundamentally bad docs for the patients. i'm still traumatized to call a surgical or specialist consult years out of my training.

so what's the hubbub about?

well, it's a fine line between a disruptive physician and a doctor who is advocating strongly for his or her patient, especially in a corrupt system where in truth, the administration, not the doctor, is disruptive and obstructionist to patient care. this is what we find in our public hospital system. when you get into the nitty gritty details, adminsitrators play out their little power games by sabotaging the OR schedule, by hiding critical surg ical instruments so that cases for poor people have to be postponed, by cancelling at the last minute a surgey because the person wasn't pre-qualified by the indigent care committee... etc, etc, etc.

in my own time, i witnesses alot of disruptive behavior by administrators but i didn't have a vocabulary word for it, i just got pissed and whined alot. in one of our FP clinics, the docs worked for a year with front desk staff to train them to be nice, to welcome patients before asking for money, to greet people and smile, all the basics. right after things started flowing more smoothly, more patients were getting in (who had no insurance) and patients were happier, the front desk staff were moved to a new location and new staff put in their place. and the cycle started all over again. DISRUPTION.

just as there are being developed mechanisms to identify and remove disruptive physicians, we need a process to identify and remove disruptive administrators, staff, insurance companies, politicians, etc. and we need to be sure that when the charge of disruption is made, that it reflects the truth around patient care. i am proud of the disruption i have caused to the buracracy. buracracy needs disruption, it needs a good kick in the ass.

andru